What Injuries Qualify for Workers’ Comp?

man hurt on stairs

Workers’ compensation can be a very complicated issue to sort out. There are a variety of different factors that come into play, and without the guidance of a legal professional, it can all be very confusing. We’re going to break down some of the basics to help you understand what injuries are eligible for workers compensation according to New York State guidelines.

What is considered a workplace injury?

Most injuries that occur on the job are covered by workers’ comp insurance, including accidents and illnesses caused by exposure to work activities, materials, and equipment.

Workers’ comp generally doesn’t cover:

  • Stress or other psychiatric disorders
  • Self-inflicted injuries
  • Injuries caused by fighting or horseplay
  • Injuries incurred while committing a crime, while under the influence of drugs or alcohol, or while violating company policies

An employee is generally eligible for workers’ comp benefits if all of the following statements are true:

  • The injured worker is an employee of your small business (not an independent contractor)
  • The employee was hurt as a result of job-related duties

What Injuries Qualify for Worker’s Compensation Insurance?

  1. Occupational Illnesses – Occupational illnesses or diseases are considered any illness or disease that employees develop because of on-the-job exposure. This can be anything from chemical poisoning, contact dermatitis, to an illness as critical as black lung. Many states also recognize that the nature of some occupations, like police officers and firefighters, are more dangerous than others and therefore require special workers’ comp protection.
  2. Repetitive Motion and Overuse Injuries – Repetitive motion and overuse injuries typically occur in positions where a person is making the same physical movements repeatedly, resulting in something called Repetitive Strain or stress injuries (RSIs). Jobs in which RSIs occur most often can range from contractors building houses, to graphic designers and writers. Repetitive strain or stress injuries include carpal tunnel syndrome, tendonitis, back pain, and more. These injuries are increasingly common and can be incredibly painful and debilitating. Workers’ comp typically covers work-related RSIs; however, they may require employees to provide stronger evidence that the condition is in fact work related. Additionally, a few states have special restrictions on claims for cumulative trauma.
  3. Pre-Existing Conditions – You might think having a pre-existing condition would count you out for workers comp, but there are a few circumstances in which you may still qualify. The kind of coverage and benefits workers’ compensation gives varies depending on where your pre-existing condition came from. If, for example, the condition is from a previous work-related injury, which you are receiving workers’ compensation for, then you will likely be able to get additional workers’ compensation if your job has further aggravated or contributed to another condition.
  4. Hearing Loss – Hearing loss can occur over time in those who work in noisy environments like construction sites or other manufacturing jobs. Unless there’s another obvious reason for the condition, workers’ comp will usually cover hearing loss.
  5. Stress-Related Injuries – In the last few years the medical community has recognized the connection between long-term exposure to stress and both physical and psychological illness. While there have been instances in which these claims have won and gotten workers comp, proving that workplace stress caused these illnesses is extremely difficult. Work with legal professionals like EMD Law to be sure to know what qualifies in New York State.
  6. Stress Resulting from Work-Related Physical Injuries – In the reverse of the previous situation, a claim in which stress resulted from a workplace injury, the rules are generally less strict. Following any injury, the pain, isolation and life changes that come with navigating those injuries can lead to sleep disorders, depression and anxiety. For that reason, these injuries are considered “compensable consequences” of the original work-related injury, which means that the injured employee should be entitled to treatment and other benefits.
  7. When Employees Are Partly at Fault for Work-Related Injuries and Illnesses – From the standpoint of employees, workers’ comp is a no-fault system. There may be exceptions to this rule if injuries were self-inflicted, or injuries happened because the workers were under the influence of drugs or alcohol, were committing a serious crime or were violating company policy. There have been cases in which an employees’ own behavior played a role in developing an illness, but they were covered by workers’ comp because job conditions also contributed.
  8. When an Employee Dies Because of Work Injury or Illness – In the event an employee dies due to work injuries or illness, their eligible dependents can collect workers’ compensation death benefits. These benefits are typically limited to a spouse, children, and other family members who lived with and depended on the employee for financial support.

How Can Erwin, McCane & Daly Help You?

The rules for workers’ comp coverage of injuries and illness can be very complicated. If you suffered a cumulative trauma injury, occupational illness, or stress-related physical or emotional injury because of work, you could have trouble getting the benefits you deserve without the help of an attorney. Our workers’ compensation attorneys are here to help you navigate the process. Contact Erwin, McCane & Daly today for your free consultation on your workers compensation case. We strive to ensure our clients’ success.