When Does an Injury or Illness Qualify for Workers’ Compensation?

Most states require businesses to provide workers’ compensation insurance to employees who may sustain physical or occupational injuries or illnesses due to performing their jobs. These are the conditions that usually qualify workers for benefits.

Regular Employment Status

In most states, permanent employees who work full or part-time are eligible to receive workers’ compensation insurance. However, workers who fall under the following categories usually do not qualify for the benefit:

  • Agricultural workers
  • Clergy
  • Independent contractors
  • Railroad and maritime workers
  • Seasonal workers
  • Undocumented workers

Although volunteers are usually exempt from receiving workers’ compensation benefits, some states allow them for volunteer police and firefighters.

Physical Injuries

Bodily injuries account for a large percentage of annual workers’ compensation claims. These injuries typically involve:

  • Broken bones
  • Lacerations
  • Burns
  • Contusions
  • Eye injuries

Injuries that qualify may occur while workers travel between job-related sites or for specific job-related purposes, such as making deliveries.

Aggravation of Pre-existing Conditions

Insurance providers may attempt to deny workers’ compensation benefits for a new injury to a body part with a pre-existing medical complication such as arthritis, disc herniation, or muscle strain. Still, if a work-related injury aggravates a pre-existing injury or condition, a worker may file a successful workers’ compensation claim.

Overuse or Repetitive Motion Injuries

Workers whose jobs require them to perform the same movements throughout the day are prone to injuries. Examples of overuse and repetitive motion injuries include carpal tunnel syndrome, muscle strain, bursitis, epicondylitis and tendonitis.

Workers who experience chronic discomfort while performing a job should seek medical attention as soon as possible to promptly acquire a diagnosis of repetitive strain injury and alert their employers.  

As a workers’ compensation lawyer like one from Therman Law Offices can explain, most states also require workers to visit an employer’s physicians for additional assessments and documentation.  

Exposure Illnesses

Workers in occupations known for daily exposure to harmful substances or circumstances not usually encountered in everyday life may develop acute, chronic or irreversible conditions qualifying them for benefits. For example, a lab technician who contracts an illness from handling a specific substance in a lab or factory and construction workers who develop job-related tinnitus and hearing loss due to excessive noise can submit workers’ compensation claims. 

Mental Stress

Workers’ compensation insurance usually covers emotional and mental stress due to work-related stress, such as post-traumatic stress following a fall, workplace explosion or ceiling collapse or unusual events, including workplace robberies. Still, emotional stress related to job performance expectations or unpleasant working conditions is usually exempt from coverage.

Speak with a workers’ compensation lawyer to advise you about your rights if you or a family member experience a work-related injury or illness.