Every year, millions of Americans go to work and suffer from a work-related injury or illness. These can range from minor injuries and health conditions to more severe cases where they can no longer work in their previous capacity or injuries resulting in death. These life-altering events can leave the injured with hefty medical bills, lost wages, and emotional trauma. 

Workers’ compensation insurance can help provide injured employees with the financial means to recover as best as possible from their injury or illness. To qualify for this assistance, you must prove that the injury is work-related and not a non-work-related condition or intentionally self-inflicted. 

So, what is considered a work-related injury? Understanding what constitutes a workplace injury or illness is key to ensuring you receive the benefits you deserve so you can focus on healing rather than stressing out about expenses. 

What is a work related injury?

The Purpose of Workers’ Compensation

Workers’ compensation is an essential insurance system that protects employers and employees when workplace injuries or illnesses happen. It’s considered a no-fault system that provides financial benefits to workers who suffer a workplace injury or illness, regardless of who was at fault for the incident that caused the injury. 

These benefits will help provide financial support for the employee’s injury. This includes medical expenses, rehabilitation, and lost wages. Workers’ comp might cover vocational rehabilitation and non-economic damages in more severe cases. The workers’ comp system serves these purposes: 

  • Protecting employers from lawsuits for work-related injuries and illnesses 
  • Ensuring injured employees receive the required medical care and financial support they need to return to their pre-injury state as best as possible 
  • Facilitating injured workers’ return to work when possible 
  • Promoting occupational safety and injury prevention 

Eligibility for Workers’ Compensation

Unlike other benefits, where workers must wait anywhere from 60 to 90 days or more to qualify, most employers make workers eligible for workers’ compensation from the first day of employment. Coverage usually extends to: 

  • Full-time employees 
  • Part-time employees 
  • Temporary workers 
  • Seasonal workers 

Volunteers and independent contractors might sometimes be eligible for workers’ comp benefits. This depends on state laws and specific circumstances. Certain workers are usually exempt from receiving these benefits, including: 

There are almost always exceptions regarding what’s covered under workers’ comp. That’s why it’s essential to fully understand your employer’s coverage, state laws, and any other exceptions to the traditional criteria that might play a role in your claim. 

Defining a Work-Related Injury or Illness

 A work-related injury or illness is any condition caused by employment-specific activities or workplace conditions. For example, if an injury is from preparing food or personal grooming, and that’s not part of your job, it may be considered a non-work-related event. 

However, the specifics of work-related injuries and illnesses can vary based on jurisdiction and circumstances. 

The “Arising Out Of and In the Course Of” Employment Standard

To be eligible for workers’ compensation benefits, injuries must come from work-related accidents or incidents. For an injury to be considered work-related, it needs to meet the following criteria: 

  • “Arising out of” employment: The work injury has to result from a risk that’s connected to the work itself. This means that we need to be able to find a casual connection between one’s employment and work injury. 
  • “In the course of” employment: The injury or illness has to happen while the employee participates in work activities or otherwise furthers their employer’s interests. For example, if an employee eating suffers an injury, they may not be eligible for workers’ compensation. 

The standard above helps determine whether an injury qualifies for workers’ compensation benefits. Since there are several gray areas when determining whether an injury was work-related, this standard helps give injured workers, insurance companies, and their attorneys a starting point. 

For example, you’ll likely meet both criteria if you slip and fall while performing your regular job duties. On the other hand, if you slip and fall while on your lunch break at a restaurant off your employer’s premises, you might not qualify unless you were having a business lunch. 

Injuries Occurring on the Employer’s Premises

Workers’ compensation laws cover most employee injuries while on their employer’s premises. This includes work-related injuries that occur before or after your official work hours. Potential employer premises are: 

  • Bathrooms and hallways 
  • Office buildings and workspaces 
  • Break rooms and cafeterias 
  • Company parking lots and garages 
  • Company-owned outdoor areas 

It’s important to remember that just because an injury occurred in one of these locations, it must be work-related or reasonably related to qualify for workers’ compensation. 

For example, suppose you’re playing basketball with your coworkers on your lunch break in the employee parking lot and are injured. In that case, you might be denied coverage unless your employer-sponsored or encouraged the game. 

Injuries Occurring During Work Activities

Most people believe work-related injuries must happen at your workplace, but that’s not always true. You can still seek coverage if you’re injured while performing work-related activities off your job site. Workers’ comp coverage extends to workplace injuries at any location, including: 

  • Work-related errands 
  • Client sites or customer locations 
  • Remote work locations 
  • Company-sponsored events 
  • Business trips and conferences 
  • Driving for work purposes outside of regular commuting 

Injured workers who aren’t sure if their injury or car accident happened off their worksite will qualify for workers’ compensation and benefit from speaking with a workers’ compensation attorney. They’ll be able to listen to the specifics of an injury, further investigate, and then determine the best avenue for compensation. 

Occupational Diseases

Occupational diseases develop over time due to various workplace conditions or exposure to chemicals. 

Suppose you’re trying to file a workers’ compensation claim for an occupational illness. In that case, you must prove your disease isn’t a pre-existing condition and was directly related to occupational hazards. Examples of an occupational injury or diseases that workers’ comp covers are: 

  • Joint problems from repetitive motions 
  • Cancer from exposure to carcinogens 
  • Respiratory conditions from exposure to harmful chemicals or substances 
  • Noise-induced hearing loss
  • Skin problems and conditions because of exposure to chemicals

Injuries Typically Covered by Workers’ Compensation

Workers’ compensation benefits cover a wide range of injuries. Understanding what work-related injuries are covered is essential to know if you have a valid claim. 

Traumatic Injuries

Workers comp covers injuries sustained in an accident while on the job. The main exceptions to this are if the injury happened due to actions outside the scope of someone’s duty, they violated safety protocols, or they were intoxicated. Some examples of a traumatic injury that may be considered work-related are: 

It doesn’t matter how minor or severe the injury is if it is considered work-related. Employers must protect employees, and a workers’ compensation claim will help with medical expenses and more. 

Repetitive Stress Injuries

Injuries from accidents in the work environment aren’t the only occupational injuries that workers’ comp covers. Injuries and illnesses caused by repeated motions or prolonged positions are covered, too: 

  • Back pain 
  • Neck pain 
  • Carpal tunnel syndrome 
  • Tennis elbow 
  • Tendonitis
  • Hip problems
  • Shoulder problem 
  • Knee injures 

Proving that these injuries are work-related requires proof of medical treatment and evaluation. It also needs to show that the injury started at work and continued to get worse over days, months, or years of performing one’s job duties. 

Occupational Illnesses

In some cases, the work environment or job duties can cause occupational illnesses. These usually don’t present right away, but they can. Some occupational injuries and illnesses that worker’s compensation covers are: 

  • Infectious diseases in a healthcare setting 
  • Respiratory diseases from chemical and dust exposure 
  • Vision problems from eye strain in the work environment
  • Mesothelioma from asbestos exposure 
  • Skin conditions from chemical contact 
  • Heat-related illnesses 
  • Cold-related illnesses 
  • Hearing loss from noise exposure 

Mental Health Conditions

Workers’ compensation is known to cover mental health conditions as long as they’re work-related and not pre-existing. They might be covered if the pre-existing mental illness is exacerbated because of job duties in the work environment. Some mental health conditions covered by workers’ compensation include: 

  • Panic attacks 
  • Anxiety disorders
  • Depression 
  • Post-Traumatic Stress Disorder (PTSD)
  • Emotional trauma from workplace incidents 
  • Stress-related conditions 
  • Mental strain from workplace harassment 
  • Sleep disorders 

Injuries Typically Not Covered by Workers’ Compensation

Despite an accident or injury happening in the work environment, not all injuries and illnesses are covered under workers’ compensation. Certain injuries won’t qualify for these benefits, which you should be aware of. 

Injuries Occurring Outside of Work

Workers’ compensation benefits don’t cover injuries that happen outside of the employer’s establishment or personal tasks outside the scope of one’s work. This includes injuries from: 

  • Off-dutty recreational activities 
  • Regular commuting accidents 
  • Personal errands during work hours 
  • Personal activities while on break 
  • Horseplay or fighting 
  • Non-work-related medical conditions 
  • Violation of company safety policies
  • Employee volunteering for blood donation in the company parking lot

While the above are typically not covered, there are some exceptions. For example, you might be entitled to workers’ compensation benefits if you suffer injuries while running an errand for your boss while on the clock. These exceptions are one of the main reasons you should consider hiring a workers’ comp lawyer. 

Self-Inflicted Injuries

Self-inflicted injuries are another type of injury that workers’ compensation will generally not cover. This includes injuries such as: 

  • Injuries incurred from starting a fight 
  • Injuries from reckless behavior, especially when it violates company policies 
  • Intentionally injuring oneself 
  • Injuries from practical jokes
  • Violations of any known safety rules 

Injuries Caused by Intoxication

If you suffer a work-related injury because of the following, it will more than likely not be covered by workers’ compensation: 

  • Alcohol intoxication 
  • Illegal drug use 
  • Self-medication
  • Working while impaired 
  • Prescription drug abuse 
  • Any other violations of drug-free workplace policies 

The Importance of Legal Advice

Navigating through workers’ compensation claims can be stressful and complicated, but having our Chicago workers’ comp lawyers on your side can make all the difference in your case’s outcome. 

Determining if Your Injury is Covered

A workers’ comp lawyer can help you determine if your injury is covered under worker’s compensation in the first place. We’ll do so by: 

  • Listening to the circumstances of your injury 
  • Thoroughly investigating the injury to determine if it’s covered 
  • Determining what damages you should seek 
  • Identifying all the potential liable parties, aka sources of compensation  
  • Gathering all the necessary evidence to prove that your injury is covered 

Throughout the process, we’ll ensure your questions are addressed immediately. Their main goal is to seek compensation on your behalf and protect your rights. 

Navigating the Claims Process

The claims process can be complicated and taxing for someone healing from a work injury. Whether you’re seeking workers’ compensation for an injury or illness, an experienced attorney will:  

  • Handle all the paperwork and documentation 
  • Communicate and negotiate with insurance companies 
  • Protect your rights throughout the claims process 
  • Ensure that you’re receiving fair compensation based on the damages incurred 
  • Guide you through the complex process of medical evaluations 
  • Represent you in hearings 
  • Negotiate settlements 
  • Fight any denial claims if it comes to that 

Secure Expert Legal Counsel!

If you have to deal with workers’ compensation because of a work-related injury, Rosenfeld Injury Lawyers is here to help the process go as smoothly as possible. Our Chicago personal injury lawyers can help negotiate with insurance companies on your behalf to get benefits that reflect your injuries. 

We will hear the details of your claim and then ensure we’re fighting for the maximum compensation so you can focus on healing and getting healthy again. Contact us today for your free consultation at (888)-424-5757 or by filling out our contact form.