What Injuries are covered by Workers' Compensation?

Workers' comp benefits pay for any injuries or illnesses that occur in the "course of employment." You can receive benefits if you were either injured at work (for example, you slip and fall on a wet floor) or if something in the work environment causes you to become sick (for example, you are exposed to a chemical that causes lung disease).

There are different rules for coverage depending on whether you have a work-related injury or disease. It is often easier to show that an injury occurred in the course of employment than to prove a disease is work related.

Injuries
An injury is covered if it happens while you are working. The injury does not have to be the result of an accident. You could be eligible for workers' comp if you were injured from repetitive motion (e.g., carpal tunnel syndrome) or from lifting something heavy (e.g., pulled back muscle). It also doesn't matter whether you were at fault; an injury is covered even if you acted carelessly.

You don't physically have to be at work for an injury to be covered. For example, if you are injured on a work-related business trip, you are covered by workers' comp. A repairman who is injured on a house call is also covered. Almost any injury that occurs while you are doing something work related is covered.

Under the "coming and going" rule, injuries that occur on the way to or from work are not covered by workers' comp. According to most courts, these injuries have nothing to do with your job. The exception to this rule is when you are on call. If you are called in to work for a special emergency and are injured on the way into work, you are probably covered by workers' comp.

If driving is a part of your job, however, you are covered by workers' comp. Employees who make deliveries or have to drive between company sites are covered by workers' comp if they get into an accident. You may be covered even if you make a slight deviation in your route.

Example: An employee who is injured while making a one-block detour from his or her normal route to mail a letter is covered under workers' comp. If you go completely off course, however, you may not be entitled to benefits. For example, workers' comp may not cover an employee who is injured while traveling 10 blocks out of his or her way to make a personal bank deposit. Of course, if you are not covered by workers' comp, you may still have a claim for damages against the other person involved in the accident.

State restrictions on coverage for injuries
Some states restrict coverage for injuries caused by an employee's own "willful misconduct," the definition of which varies from court to court. A personal fight with another employee is generally not covered under workers' comp unless the fight is somehow related to work. For example, an employee might be covered by workers' comp if he or she was involved in a fight while protecting the employer's belongings or property. You may also be covered if a coworker, client, patient or third party attacks you at work.

Some courts also won't award workers' comp benefits if the injury resulted from a worker's horseplay. The injury may be covered, however, if the employer condoned the employee's behavior. For example, if an employer regularly allows employees to play games at work during break times, an injury resulting from the games would probably be compensable.

The same is true for company athletic teams. Whether an injury that occurs during a company athletic competition is covered depends on the employer's involvement in the team. If the employer sponsors the team, provides uniforms, and, in turn, reaps benefits such as advertising and increased employee moral, then injuries are more likely to be covered by workers' comp.

Another set of injuries that workers' comp does not cover are those resulting from alcohol or illegal drug use.

If an employee dies on the job, it is usually assumed the death was work related. The employee's beneficiaries are entitled to money for funeral expenses and the employee's lost wages for a time period determined by the circumstances.

Occupational diseases
In addition to covering accidents and injuries, workers' comp also covers illnesses that occur as a result of something at work. For an illness to be covered, the job has to somehow increase the chances of getting the illness, and there must be a clear connection between the job and the illness. The burden is on the employee to show that his or her working conditions or environment caused the illness or disease. For example, if you are regularly exposed to asbestos at work and later get cancer, you may be able to collect workers' comp. But you would have to show that your exposure to the asbestos at work was your only exposure. If you were also exposed to asbestos or some other carcinogen (cancer-causing agent) at home, your illness would probably not be covered.

Some state laws list illnesses that are presumed to be work related if they occur in a certain occupation--usually firefighting or police work. In these cases, you don't have to prove your working conditions caused the disease or illness; it is assumed. For example, a Nevada state law states that for firefighters and police officers who get heart disease after working five or more years, the heart disease is presumed to be work related unless proved otherwise. In Louisiana, any heart or lung disease occurring in a firefighter is presumed to be work related.

Psychiatric disabilities
In some circumstances, a psychiatric disability (e.g., stress disorder) can be covered by workers' comp. Examples of mental disabilities that may be covered by workers' comp include:

• a delivery driver who is involved in a car crash and has post-traumatic stress syndrome as a result and
• an employee who has a panic attack after a supervisor harasses her.