Determining if Your Injury Can Be Covered Under Workers Comp

10 April 2017
 Categories: , Blog


Workers compensation is a type of medical coverage that helps to pay for treatment, prescriptions, and time off work due to a work-related injury or illness. However, there are some stipulations about what is and isn't covered under workers compensation. Here are some questions to ask yourself when figuring out if your injury might be covered.

Is the Injury or Illness Mental or Physical?

With a work-related injury or illness, it is more easily covered if it is a physical injury, but that doesn't mean mental issues related to your job aren't covered. It just might take a little more evidence to show it is from your job. This could be extreme stress from your job, such as taking on more work than you were supposed to have, which caused emotional stress and then physical illness. You may have witnessed something traumatic at work which caused PTSD or anxiety, other mental illnesses that might be covered.

Were You Performing Work Tasks on the Premises?

For workers compensation to cover diagnosis and treatment of your injury, it needs to be the result of your occupation, typically while on the premises. There are some exceptions, like if you were traveling for work or running a work-related errand, which then resulted in an accident. However, if you are on your lunch break and get into a vehicle accident, that is not going to be covered by your workers comp policy.

Is it at all Related to a Pre-Existing Condition?

This is a tricky one, because some pre-existing conditions might lead to your current injury, which is only partly work related. For example, if you have had wrist pain and problems in the past, but it didn't turn into carpal tunnel syndrome until your current occupation because you use your hands and wrists a lot for your job, that might still be covered. On the other hand, if you had carpal tunnel syndrome before, and try to claim the injury is from your current job, that is likely not covered since you already had the condition.

Was it Related to Misconduct on Your Part?

While injuries that are related to a mistake you made or even due to negligence as long as it is work-related, injuries caused by misconduct are often excluded from coverage. This might include being intoxicated while on the job or doing something else at work that is not allowed. There is a line to be drawn between negligence and misconduct, so it is important to know the difference.