Workers Compensation: Medical Issues and Injuries Covered

<< Page 1: Overview of Workers Compensation

Employee workers’ compensation claims are generally viewed as a no-fault system, which allows employees to collect benefits regardless whether they had any fault in causing their work-related injuries.  Keep in mind; however, injuries involving substance abuse, intoxication on the job, fighting, criminal activity, or some other form of gross and willful misconduct are not covered by workers’ compensation benefits in most cases.  Even then, as long as an employer is partially liable for allowing an injury to occur, gross and willful misconduct causing injury may still be covered under workers’ compensation benefits in your state.

Establishing a general legal boundary for injuries covered by workers’ compensation benefits would include the following elements:

  • Injury occurred during company or work-related environment, including work offsite, travel to offsite work locations, aggravated future injuries, and even, injuries sustained at company functions like picnics
  • Injury caused by either immediate one-time event accident or through the course of repeated action
  • Increasingly, psychological damage caused by employment
  • Virtually any injury incurred directly as the cause of or during the course of employment

Illnesses Covered by Workers’ Compensation Benefits

Occupational disease, or work-related illnesses, occurs as soon as one’s employment increases a workers’ potential to acquire that given illness.  Proving illnesses or medical problems, such as heart attacks or other immediate medical events, requires a direct link between the employment and the present disease or sickness.  You should keep in mind, however, that insurance companies covering employers will probe all other areas of your past life and medical history, especially those items which may have also potentially attributed to the illness you are claiming for workers’ compensation benefits.

The definition of disease or illness is also changing to cover different aspects of one’s health.  In essence, if an illness prohibits an employee from working and is work-related, it will probably be covered by workers’ compensation laws.  Interestingly, some states recognize mental disorders, psychosomatic symptoms, and general stress as work-related illnesses and compensate workers accordingly.

Deaths Covered by Workers’ Compensation Benefits

Deaths in the workplace are more common than most employers want to acknowledge, and estimating the value of workers’ compensation claims in the event of an employment-related death is difficult to say the least.  Essentially, dependents, spouses, or the owner of deceased person’s estate are awarded workers’ compensation for their loved one who died as the result of work-related illness, injury, or even if the cause of death is unclear and the deceased is found at work.  If conclusive evidence supporting self-inflicted death or homicide unrelated to work in any way appear, benefits may be withheld, but the evidence needs to probably prove one or the other well beyond a shadow of a doubt.

Am I Entitled to Medical Care under Workers’ Compensation?

For injuries sustained at work, employees are entitled to receive immediate medical care.  If you already have a preferred doctor or healthcare professional whom you want to treat you, it is important to send a request to your employer informing them of your intentions to seek care from that individual in writing.  Without filing a request to your employer, injured workers will be mandatorily sent to a doctor of the company or insurance company’s choice for the first thirty days of care.  In many cases, these doctors’ diagnosis will most likely be reserved to say the least, and probably prove detrimental to your claims and personal health.

As a rule, approved workers’ compensation claims require your employer’s insurance company to cover all medical expenses related to an approved remedy to this injury or illness.  This medical coverage will continue once a worker returns to work, if any necessary medical treatment related to the injury is necessary. 

How Do You File a Workers’ Compensation Claim

If you are considering your eligibility for workers’ compensation benefits, make sure to check in with all the applicable workers’ comp laws in your specific state of employment.  Each state administers their own workers’ compensation program, and in many instances, the applicable process may differ greatly.

In general, a workers’ compensation claims process should begin with immediate and documented medical care to treat injuries or illness as soon as symptoms appear.  Then, most states require workers to notify their employers about work-related injury or illness with a few days up to one month later.  Injured or ill workers can acquire the necessary form to file from their employer, or if necessary, from their local workers’ compensation office.  A common practice for employers and their insurance carriers is to dispute workers’ compensation claims if at all possible, and if you are able, obtain and document any piece of evidence supporting your claim including medical records, statements, company policies, working conditions, and emails from employers. 

Applicable benefits you can obtain from a workers’ compensation claim filing vary by state, but below is a list of some of the more commonly distributed workers’ compensation benefits when applicable:

  • Medical treatment costs, including immediate hospital treatment and continued medical treatment and rehabilitative therapy
  • Lost income, depending on state maximums and minimums, at a rate of about sixty-six percent of your usual wage, which are also tax-free income
  • If forced from your field of employment, vocational rehabilitation benefits could be provided
  • Lump sum medical payments in the event of permanent total disability and permanent partial disability
  • Death benefits to family members and relatives for burial expenses and lost income of the deceased at a rate of about two-thirds of weekly salary for a state-limited period of time
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