What Qualifies as a Workers’ Compensation Injury?

What qualifies as a Workers' Compensation injury? Fishbowl Blog

Some workplace injuries are cut and dry. For example, you’ve cut your finger or fallen at work on the clock. Other times, prolonged work conditions cause you to develop an illness, or the injury itself was deemed, either by you or management, as not “severe enough” to make a claim.

Multiple misconceptions surrounding workers’ compensation can lead to employees neglecting their own rights or insurance coverage. To ensure that you follow the right steps after an injury, you’ll need to understand what type of trauma qualifies you for a workers’ compensation claim.

What Is Considered a Workplace Injury? 

Most injuries that occur on the job are covered by workers’ compensation insurance, including illnesses and accidents caused by work activities, equipment, and materials. To ensure you qualify for workers’ compensation, review your Medicare coverage options before applying.

When a workplace injury occurs, time is of the essence. The employee has a limited number of days to file a report and collect benefits. Employees should report an occupational injury the moment it occurs. If there’s a delay, there’s a possibility an insurer could deny your claim.

What Isn’t Considered a Workplace Injury? 

Insurance companies won’t file a claim if your injury consists of the following:

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

Are There Exceptions to These Rules?

Several of these rules aren’t set in stone, as prolonged injuries or illnesses could be considered a workplace injury and permissible for a claim. For example, if an accountant develops carpal tunnel syndrome through prolonged typing, they may be able to make a claim if the accountant:

  • Didn’t overexert themselves in their role.
  • Took an extended leave of absence to recover.
  • Is considered “too young” for the illness to become chronic.
  • Only types for prolonged periods at work.
  • Has an injury that occurred at work and was written down.

At the same time, the accountant may be exempt from making a claim if they were fully aware that their job could eventually lead to an injury. This is called an “occupational disease.” 

Accidents are much easier to prove, but with a condition like carpal tunnel, it’s unlikely you’ll experience a sudden and violent trauma that causes it. You’re more likely to develop carpal tunnel through exposure, making the injury more difficult to prove but not impossible.

To prove an occupational disease as a compensational injury, you’ll have to show that, as an employee, you suffered greater exposure to the disease than the general public. You would need statistics or some other matter of proof to show your profession is especially at risk.

What if the Injury is Considered “Minor?”

Employers may discourage employees from making a workers’ compensation claim, either directly or indirectly. Too many workers' compensation claims could send off a red flag to inspectors who may shut down the business if they find conditions to be unsafe.

What Sets Off Alarm Bells

The profit motive definitely plays a part, but employees may feel their job is at risk if they make a claim. However, minor injuries, like cuts and scrapes, aren’t a cause of alarm to inspectors. 

It’s only consistent serious injuries, like concussions, broken or missing limbs, or near-misses, that alarm inspectors. If a workplace is dangerous, it’ll inevitably be shut down through spot inspections. Still, making a claim when you’re pressured not to do so is easier said than done.

What Employees Can and Should Do

If your injury is considered “minor,” you should file your claim immediately, regardless of severity. Even scrapes and bruises should be reported. A caring employer will notice that injuries are occurring more frequently and do their due diligence to prevent them in the future.

What’s more, smaller injuries could masquerade as serious wounds. For example, a bump on the head may seem minor to you, but you could be concussed or bleeding internally. 

Employers aren’t legally allowed to fire you for making a claim. However, it can and does happen. It’s essential to keep your claim in your records in case you need to file a wrongful dismissal suit or if you want to call an inspector/union worker to investigate.