Usually, if you were doing something for the benefit of your employer, and you were injured or became ill as a result, then your injury or illness is work related and you can receive benefits (as long as you meet the other eligibility requirements).
The AOE/COE requirement may seem like a simple rule, but it can get tricky. Some common situations are covered below.
Usually, injuries that happen on an employee's lunch break are not considered work-related. For example, you probably can’t claim workers’ comp for spraining your ankle while walking to a deli to pick up your lunch (or lunch for your coworkers). But the injury might be covered if you were also picking up lunch for your boss.
If you were hurt while eating lunch on the company's premises (especially in an employee cafeteria or lunchroom), the injury will generally be considered work-related. But it probably won’t be covered if you were doing something during the lunch break that wasn’t allowed or fell within other exceptions to workers’ comp coverage.
For instance, in a case where an employee was injured during one of her regular lunch-hour “power walks” on company grounds, a Connecticut court found that the injury was “incidental” to her employment but came within the exception in state law for voluntary recreational activities. (Brown v. United Technologies Corp., 963 A.2d 1072 (Conn. Ct. App. 2009)).
Many companies sponsor special events like parties, picnics, or baseball games. Injuries sustained at these events are usually considered work related. But some states make an exception if the employer doesn’t expect employees to participate in the off-duty events.
Under what’s known as the “going and coming rule,” workers’ comp generally doesn’t cover injuries sustained during your commute to or from work. There are exceptions to this rule, however, including when you’re:
As more and more employees work from home at least some of the time, the question of workers' comp eligibility for at-home injuries has been raised frequently. The answer depends on the laws in your state and the facts of your case.
In general, if you suffer an injury while you're working from home and it was arguably work-related, you'll be eligible for workers' comp. For example, if you suffer from carpal tunnel syndrome related to work-related typing, you'll probably be covered. If you fall down the stairs while walking to your home office, that might be covered as well. Falling off a ladder while you're trimming the trees in your yard during work hours? Not covered.
If you were injured while breaking a workplace safety rule or while doing something else that your employer has prohibited, your injury might still be covered by workers' comp, depending on the level of your misconduct and where you live. This is part of the workers' compensation bargain: Employees do not have the right to sue their employer for work-related injuries, but those injuries are usually covered by workers' comp, regardless of fault.
There are some exceptions to this general rule. Workers’ comp usually doesn’t cover injuries that happen because the employee was drunk or using illegal drugs. Several states also rule out workers’ comp coverage when the injured employees were:
However, courts may consider injuries involving rule-breaking or horseplay to be work related if the employer knew about and condoned the behavior, or it was a common or accepted part of the working environment.
Workers’ comp may also cover cumulative injuries developed over time (such as repetitive strain or stress injuries or RSIs), occupational diseases and other illnesses resulting from on-the-job exposure, and physical or psychological illnesses resulting from workplace stress.
But in these cases, it may be difficult to prove that the injury or illness is work related—especially in the case of infectious diseases. The rules may also vary from state to state, especially when it comes to stress-related and emotional illnesses. Learn more about injuries and illnesses covered by workers’ compensation.
If your work aggravated or “lit up” a pre-existing condition, the aggravation will probably be considered a work-related injury.
If your injury or illness falls into a gray area for workers’ comp coverage, it would be a good idea to consult with an attorney to find out whether you might be eligible for benefits.
An experienced workers’ comp lawyer can explain how your state’s laws apply to your particular situation. (To learn about your legal options if you aren’t eligible for workers’ comp, see When You Can Sue Outside of Workers' Compensation.)
]]>In exchange for this protection, you lose the right to file a lawsuit against your employer for damages (except in a few situations when you can sue outside of the workers’ comp system).
Typically, there are four basic eligibility requirements for workers' comp benefits:
There are special rules for some categories of employees, including domestic workers, agricultural and farm workers, casual or seasonal workers, and workers placed with an employer by temp agencies.
Let's take a closer look at the basic eligibility requirements and some of the special rules.
Generally speaking, the vast majority of employers—but not all of them—are required to have workers' compensation coverage. State laws vary, but an employer's responsibility to provide coverage generally depends on how many employees it has, the type of business it is, and the type of work employees are doing.
Most states require any employer with at least one employee to have coverage, but some states set a minimum of two to five employees. A few states have different requirements for agricultural or construction businesses, and some allow charities to opt out of the workers’ comp system. Texas stands out by making workers’ comp coverage optional for almost all private employers (Tex. Labor Code § 406.002 (2024).)
Many employers buy workers' comp insurance even if they aren't legally required to do so. Typically, state laws allow these exempt employers to "opt in" to the workers' comp system. In that case, their employees may receive benefits for work-related injuries, but they won’t be able to file a lawsuit against the employer.
Employers usually buy workers’ comp insurance on the private market or, in some states, from a state fund. However, many large employers—especially state and local governments—assume the financial risk for their employees’ workers’ comp benefits (known as self-insurance).
The federal government has its own workers' compensation system. If you are a federal employee, you must look to that system rather than your state system for benefits. Learn more about the federal workers’ compensation system. Federal law also has separate rules for compensating injured maritime workers and injured railroad workers.
Not all workers are employees when it comes to workers' compensation eligibility. In particular, independent contractors (like freelancers, consultants, or members of the “gig” economy) typically aren’t entitled to workers' comp benefits.
But of course, many workers—including drivers for Uber, Lyft, and other ride-hailing services—claim that they’ve been misclassified as independent contractors when the hiring firm should have classified them as employees.
Employers often misclassify workers as independent contractors to avoid paying payroll taxes or workers’ comp premiums. Even if you signed a 1099 tax form as an independent contractor, you might still qualify as an employee for workers’ comp. But your dispute will probably end up in court. Although the rules vary from state to state, courts will generally look at the amount of control you have over your work and other details of your working relationship with the company or person that hired you.
Volunteers usually aren’t entitled to workers' comp benefits, but there are some exceptions. For instance, some states specifically cover volunteer fire fighters, or they give organizations the option of covering their volunteers.
Generally speaking, if you were doing something for the benefit of your employer and were injured or became ill as a result, then it's work-related. For example, your injuries are clearly work-related if you hurt your back while loading boxes as part of your warehouse job, develop carpal tunnel syndrome as a result of typing on the job, or become ill due to exposure to hazardous chemicals at the work site.
This issue may be harder to figure out in some other situations, like if you were injured during your lunch break, at a company-sponsored social event, or while horsing around with co-workers. (Learn more about the rules for deciding when injuries or illnesses are work-related.)
Even if you meet the other qualifications, you could lose your right to receive workers’ comp benefits if you don’t meet the deadlines in your state for reporting the injury to your employer and filing a workers’ comp claim. (Learn more about workers’ compensation time limits.)
Even if you meet all three of the general eligibility requirements described above, you may not qualify for workers' comp benefits if you fall into one of the categories of workers who are exempt under state law. The most common types of exempt workers include:
If your employer claims that you’re not eligible for workers’ comp benefits—because you’re an independent contractor, you fit in one of the other exemptions, or the employer isn’t required to provide coverage—you should consider consulting with a lawyer.
Employers and insurance companies routinely deny valid workers’ comp claims and do everything they can to limit their liability. An experienced workers’ compensation attorney can help even the playing field and protect your rights.
]]>I slipped and fell at work about two months ago. At that time, my back was a little sore, but I thought it was a minor problem. I didn’t report the injury or seek medical treatment. But as time passed, my back pain got worse and started to run down my leg.
My primary care doctor thinks I seriously hurt my back during the slip and fall at work. My doctor also thinks that all the heavy lifting I do at work made the original injury worse. Is it too late to file a workers’ comp claim?
When you suffer a work injury, it’s important to report it promptly. Most states have relatively short deadlines for doing so, and late reporting may result in your benefits being reduced or automatically denied.
Reporting deadlines vary from state to state. Many states, such as California and Florida, have 30-day deadlines. Other states like Iowa and Michigan give workers 90 days to report their injuries.
Still other states, such as Arizona and Hawaii, don’t specify a specific deadline; instead, they may simply require employees to report their injuries promptly or as soon as it’s practical. In Colorado, if you don’t report your injury within four days, you’ll lose a day of benefits for each day that you’re late.
If you have an occupational illness or a condition that develops gradually, such as a repetitive stress condition or chronic obstructive pulmonary disease (COPD), the time period for notifying your employer may be longer and typically doesn’t start until you discover the condition and its connection to your work. This usually happens when a doctor tells you that your job activities caused the problem.
Because your back injury worsened over time, you may still be eligible for benefits even if the deadline has passed from the date of the accident. However, now that you know your back condition is related to your job, you should report it immediately.
Insurance companies often deny claims by employees who reported their injuries late. If that happens to you, however, it doesn’t necessarily mean you won’t be able to receive any workers’ comp benefits. Most states excuse late reporting under some circumstances, at least up until a certain point. Even when you miss the reporting deadline, you still may be eligible for workers’ comp benefits if, for example:
If you report your injury now and your employer’s insurance company denies your claim, you have the right to appeal. But you should strongly consider speaking with a workers’ comp lawyer. A local attorney who’s experienced in this field can explain the rules in your state, including the reporting deadline and whether you qualify for any exceptions.
]]>To make workers’ comp insurance an effective replacement for civil litigation, virtually all state governments require that employers carry coverage. (Texas is the lone exception.) But there are certain job categories and types of business that are exempt from workers’ comp laws.
The vast majority of states require every business with at least one employee to offer workers’ comp coverage. However, there are a handful of states where the workers’ comp insurance requirement doesn’t kick in until a business has a few more employees—typically between two and five, depending on the state.
Some states exempt the following business owners from workers’ comp coverage:
In some states, a business can choose whether or not to purchase workers’ comp insurance for these individuals. In other states, business owners are automatically covered, but can opt out of coverage.
Certain types of workers are exempt from workers’ comp coverage. While these job categories vary from state to state, the most common types of exempt workers include:
Independent contractors and volunteers usually are not covered by workers’ comp because they aren’t employees. These workers are not technically “exempt”; employers don’t need to purchase workers’ comp insurance for them in the first place.
Employers are not required to offer workers’ comp coverage for independent contractors. However, the fact that a worker is called an independent contractor and receives a 1099 tax form doesn’t necessarily mean that they are an independent contractor. The legal test for whether workers are employees or independent contractors typically depends not on how they are classified, but on how much control they have over their work.
Some employers may misclassify workers as independent contractors in order to avoid paying for their payroll taxes and workers’ comp insurance. Others may intend to hire an independent contractor, but consistently treat that worker as an employee. If a worker classified as an independent contractor can prove that they were actually an employee, then they are entitled to workers’ comp benefits.
Volunteers generally aren’t entitled to workers’ comp coverage, but there are some exceptions. For example, some states require coverage for volunteer firefighters or police officers.
The federal government has its own workers’ compensation system for injured federal employees. Federal law also has separate rules for compensating railroad employees and maritime workers who suffer work-related injuries. While the system for railroad employees is not a workers' comp system—workers are required to prove their employer’s negligence and that the negligence was a cause of their injury—the system for certain maritime workers is essentially a federal version of standard state workers' comp.
To claim a workers’ comp exemption, business owners generally need to file a form with a state-approved commission or board. Even if an employer qualifies for a workers’ comp exemption for some of its workers, it may still need to purchase workers’ comp insurance for others.
Many businesses that qualify for an exemption choose to purchase workers’ comp insurance anyway. States usually allow exempt employers to opt in to the workers’ comp system. This provides benefits for employees, as well as protection from liability for employers. The cost of paying workers’ comp premiums may be significantly less than the cost of even one settlement or verdict if a worker who isn’t covered by workers’ comp files a lawsuit for an on-the-job injury.
If you were injured at work and your employer is claiming you're exempt from workers' comp coverage, consider contacting an experienced workers' compensation attorney to discuss your legal options.
A lawyer can help you file a workers' comp claim and appeal if you've been denied. And, if you're truly exempt from workers' comp coverage and your employer was at fault for your injury, an attorney can help you file a lawsuit against your employer in court.
]]>As with most legal questions, the answer depends on the particular facts of your case.
Workers’ compensation is a no-fault system, which means that if you're injured in the "course and scope of employment," you’re typically covered under your employer’s workers' comp insurance, regardless of whether your own negligence (or someone else's) played a role in the accident. While remote work life has brought this question to the forefront, workers’ compensation coverage for off-site injuries is not really a novel concept.
In general, employees are covered for work-related injuries that occur outside the office or other workplace. The primary consideration in these cases becomes whether the injury is actually work-related. Proving that your occupation caused an injury becomes more complicated when working remotely, especially when the injury could have theoretically occurred at home on any given day when you weren’t working.
Some questions that will determine whether an injury is work-related include:
For example, if you’re injured in the company’s break room while having your lunch on-site, workers’ compensation will usually cover those injuries because it benefits your employer when you take your lunch break at the office (it saves time and keeps you accessible to your team if a need arises while you’re on break). Even if you’re injured on your employer’s premises after you clock out, you will typically still be covered under the company insurance policy.
This analysis also translates to telecommuting. If you stub your toe on the way to the bathroom at midnight, you’re probably out of luck. But if you can reasonably explain how an injury is work-related, chances are you’ll get the benefit of the doubt.
Learn more about injuries and illnesses covered by workers' compensation.
Courts usually err on the side of covering employees’ injuries in workers’ compensation disputes. Taking an expansive approach to coverage serves everyone’s best interests when a worker is injured on the job. Broadly interpreting coverage typically helps:
Whether your employer was benefiting from an injury-causing activity while you were working from home might usually involve a more fact-intensive inquiry that it would if you were injured on company premises.
For example, carpal tunnel syndrome and other repetitive stress injuries are covered by workers’ compensation insurance. If you’re performing the same repetitive movements at home that you would perform at the office and sustain an injury in the process, that’s a pretty clear case for coverage.
State laws govern workers’ compensation benefits, so the rules vary depending on where you live. If you sustain an injury while working from home, your first course of action should be to file the workers’ compensation insurance forms provided by your employer as soon as possible.
You should also preserve any evidence that might demonstrate how you sustained the injury, so you’re prepared to answer any questions regarding whether you were in the course and scope of employment when the injury occurred. And if your workers' compensation claim is denied, talk to an experienced attorney about your best course of action.
]]>Here's what you need to know.
In most states, workers’ compensation provides benefits for permanent scarring or disfigurement resulting from work-related injuries or from treatment for those injures (such as surgery).
However, your eligibility for these benefits and the amount you’ll receive depend on the state you live in.
In some states, permanent scars are factored into a worker’s permanent disability rating. For example, in California, the doctor who assigns you a permanent disability rating (stated as a percentage from 0% to 100%) will take into account any scarring or disfigurement.
In other states, workers can receive a one-time payment for scars or disfigurement, up to a maximum amount set by law. For example, in Massachusetts, a worker can receive up to $15,000 for certain scarring and disfigurement.
The location of the scars may also be relevant in determining whether you’re entitled to compensation. In most states, you can receive compensation for scars on the face, head, or neck.
Some states also allow workers to recover for scarring on arms, legs, or any other body part that would be exposed under certain circumstances (in a swimsuit or at work). However, a few states provide workers’ comp benefits for scars to limbs and other body parts only if the scar causes a loss of function or limits the worker’s ability to find employment.
If you've suffered a workplace injury serious enough to leave permanent and noticeable scarring, don't hesitate to hire an experienced workers' comp attorney to handle your case.
Hiring a workers' comp lawyer gives you the best chance of getting all the benefits you deserve, and most workers' comp attorneys don't charge a fee unless you win your case.
]]>If you’re suffering from PTSD because of your job, you may be wondering if you can get workers’ compensation benefits. The answer largely depends on where you live and the nature of the event that caused your symptoms.
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V), PTSD is a cluster of symptoms that happen after someone is exposed to actual or threatened death, serious injury, or sexual violence. Some examples of workplace situations that might give rise to a PTSD claim include:
People with PTSD re-experience the original trauma in the form of nightmares, flashbacks, upsetting memories, and emotional distress or physical responses to any reminders of the original event. They also have a range of symptoms from depression and anxiety to difficulty concentrating or sleeping.
Employees can suffer work-related psychological or mental problems in three different ways. PTSD is an example of what are called “mental-mental” claims (in workers’ comp jargon), because it's a mental health problem that developed as a result of a mental or psychological condition at work.
Compared to so-called physical-mental claims (work-related physical injuries that cause psychological conditions, such as when chronic pain from a back injury leads to a sleep disorder), mental-mental workers’ comp claims are much more difficult to prove—if they’re allowed at all.
States generally have three different ways of treating mental-mental workers’ comp claims like PTSD:
In a time when mass shootings and other violence at workplaces are distressingly common, lawmakers in some states are moving to loosen the restrictions on workers’ comp claims for PTSD, especially for first responders. For instance:
If you file a workers’ comp claim based on work-related PTSD, you can expect your employer’s insurance company to scrutinize your claim very closely. This is especially true if you’ve ever filed a workers’ comp claim before.
Even when you’ve received a formal PTSD diagnosis from a psychiatrist or psychologist, investigators are likely to dig into your personal life to verify that your symptoms are genuine and related to a qualifying workplace incident. Their tactics may include checking your criminal history and credit report, interviewing your coworkers and supervisors, and reviewing your previous mental health records.
The best way to document the severity of your PTSD symptoms is to obtain consistent treatment with a mental health specialist, preferably a psychiatrist or psychologist. In many cases, PTSD symptoms don’t appear until months (or even years) after the triggering traumatic event.
When this happens, it can be especially challenging to prove that your symptoms are related to work. That’s why it’s so important to seek treatment for your symptoms as soon as you begin to experience them.
Ideally, your treating physician will carefully document your reported symptoms and provide a written opinion about how those symptoms limit or prevent your ability to work. Statements from friends, family members, and co-workers addressing your observed limitations can also help your case.
If your workers’ comp claim is approved, you should be able to get reimbursed for the costs of treating your condition. You might also qualify for temporary disability benefits when you’re out of work recovering, or permanent disability benefits if doctors concluded that your PTSD permanently limits your ability to work and earn a living. But many states place strict limits on disability benefits for psychological injuries (or prohibit them altogether).
If you suffer from PTSD as a result of an incident that took place while you were working, you should speak with a workers’ comp lawyer as soon as possible. An attorney who’s experienced in this area should be able to explain the workers' comp system in your state, including whether PTSD claims are allowed and in what circumstances.
A good workers' comp attorney can also help you file your claim, meet the strict deadlines, anticipate and counter the insurance company’s inevitable arguments against your claim, and represent you if you need to file an appeal. In addition, your lawyer will work with your doctors, therapists, and counselors to develop the medical evidence necessary to prove your case.
Generally, workers’ comp lawyers charge only a limited percentage of the benefits you win or receive in a settlement. So you don’t pay anything up front, and there’s no fee if you lose.
]]>In order to be covered by workers’ comp, injuries don’t have to result from sudden accidents like falling off a ladder or losing a finger to equipment malfunction.
It’s just as common for employees to sustain injuries or occupational illnesses that develop over time. And some workers may acquire infectious diseases (such as COVID-19) as a result of on-the-job exposure.
Whether you’ve sustained a sudden injury or a cumulative trauma, if you want workers’ comp benefits, you must prove that the injury or illness was connected to work—in legal jargon, “AOE/COE” (arising out of employment and occurring during the course of employment).
According to the Occupational Safety and Health Administration (OSHA), an illness or injury is work-related if an event or exposure in the work environment caused or contributed to it.
While AOE/COE question can be straightforward when employees are hurt from an accident at the workplace, it gets trickier when it gets trickier when they were doing something job-related away from the office (learn more about what makes an injury or illness work-related) or when they develop injuries or illnesses over time.
Workers’ compensation generally covers illnesses or diseases that employees develop as a result of on-the-job exposure. Work-related illnesses can range from traditional occupational illnesses like black lung disease (from exposure to coal dust) and asbestosis (caused by exposure to asbestos) to the coronavirus/COVID-19 (more on that below).
It may be relatively easy to prove that work conditions caused traditional occupational diseases, where the medical link is well established and exposure away from work is rare.
Proving the work connection can be more difficult when the illness is considered an “ordinary disease of life”—a condition that many people develop throughout their lives from various causes.
That doesn’t mean it’s always impossible to get workers’ comp benefits for heart disease, high blood pressure, lung cancer, or other common illnesses (unless state law explicitly rules it out).
But employees will need strong medical evidence that workplace exposure caused or contributed to the illness.
Many states recognize that jobs like police officers and firefighters are inherently dangerous and deserve special workers’ comp protection. So when those employees develop certain illnesses (like heart attacks, hernias, and some kinds of cancer), the laws presume that their conditions are work-related.
Workers’ Compensation Benefits for COVID-19?
If you can’t work because you contracted COVID-19 or were exposed to the coronavirus on the job, you might be eligible for workers’ comp benefits—including temporary disability benefits while you’re in quarantine. Your eligibility will depend on state law and your specific circumstances. As a general rule, however, you would have to show that you were exposed while you were working and that your job presented a special risk of exposure, beyond the risk for the general public.
Healthcare providers and first responders are the most obvious examples of jobs with that kind of special risk. Several states have issued rules that will make it easier during the pandemic for these employees to qualify for workers' comp benefits without proving on-the-job exposure.
Learn more about getting workers’ comp benefits for COVID-19.
Repetitive strain or stress injuries (RSIs) are increasingly common and can be incredibly painful and debilitating. And they don’t only result from keyboarding or clicking a computer mouse all day. People in a wide range of jobs who perform the same physical tasks over and over—from factory workers and home health aides to coders and graphic designers—can develop RSIs including carpal tunnel syndrome, tendonitis, back pain, and more.
Workers’ comp typically covers work-related RSIs. But a few states have special restrictions on claims for cumulative trauma, or they may require employees to provide stronger evidence that the condition is related to work.
Just because you had a pre-existing condition, that doesn’t mean you can’t get workers’ comp benefits if another work-related injury aggravated that condition.
For instance, say you hurt your back while lifting a heavy object at work, but x-rays or scans show that you had arthritis or an old injury in the same part of your spine.
The new injury is probably covered by workers’ comp because it aggravated or “lit up” the pre-existing condition. Depending on where you live, however, some of your benefits—especially permanent partial disability benefits—may be reduced to the extent that you need them because of the old injury.
People who work in noisy environments—such as construction sites or manufacturing plants—often suffer hearing loss over time. Unless there’s another obvious reason for the condition, workers’ comp will usually cover hearing loss.
The medical profession increasingly recognizes the connection between long-term exposure to stress and a wide range of illnesses, both physical and psychological. Still, it may be difficult or impossible to get workers’ comp benefits for illnesses caused by on-the-job stress, depending on where you live, the nature of your illness, and the reason for the stress.
Some states don’t recognize claims for physical illnesses caused by emotional stress at work. In Louisiana, for instance, workers’ comp covers heart disease or injury only if it primarily resulted from physical stress or exertion that was extraordinary and unusual for the job (La. Stat. § 23:1021 (2022)).
Many states allow workers’ comp claims for post-traumatic stress disorder (PTSD) and other stress-related psychological conditions, but only if they were caused by a sudden, extraordinary traumatic event at work, such as when a convenience store clerk is held up at gunpoint or a teacher has to deal with a mass shooting at school.
Even in states that allow workers’ comp claims for emotional problems resulting from ongoing job stress, employees often have to provide stronger evidence to support these claims than they would for other types of injuries or illnesses. They may also have to show that workplace conditions played a bigger role than other factors.
In California, for instance, employees usually have to prove that working conditions were the "predominant" reason (meaning they were at least 51% responsible) for their psychiatric injuries (Cal. Labor Code § 3208.3 (2022)).
The rules are different—and generally more liberal—when employees develop emotional or mental conditions as a result of their work-related physical injuries. The pain, isolation, and life changes that come with serious physical injuries and disabilities often lead to sleep disorders, depression, and anxiety.
These conditions are generally considered a “compensable consequence” of the original work-related injury, meaning that the injured employee should be able to get treatment and other benefits.
From the standpoint of employees, workers’ comp is a no-fault system. It doesn’t matter if workers were careless when they were injured. There may be exceptions, however, such as self-inflicted injuries or injuries that happen because the workers were drunk or high, were committing a serious crime, or were violating company policy.
Even when employees’ own behavior played a role in developing an illness, it may be covered by workers’ comp if job conditions also contributed to the disease. In one case, a brewery worker claimed that his employer contributed to his alcoholism by giving employees as much free beer as they wanted to drink during their breaks.
Although alcoholism is an “ordinary disease of life,” and the employee didn’t have to drink as part of his job, the appellate court found that he was still entitled to workers’ comp benefits, because the “unique circumstances of the employment shaped the course of [his] disease.” (Gacioch v. Stroh Brewery Co., 466 N.W. 2d 302 (Mich. Ct. App. 1990).)
When employees die as a result of work injuries or illness, their eligible dependents are generally entitled to collect workers’ compensation death benefits. Usually, death benefits are limited to a spouse, children, and other family members who lived with and depended on the employee for financial support.
The rules for workers’ comp coverage of injuries and illness can be very complicated. They also differ considerably from state to state. If you suffered a cumulative trauma injury, occupational illness, or stress-related physical or emotional problem because of work, you could run into trouble getting the benefits you deserve without the help of an attorney.
An experienced workers’ comp lawyer can analyze your case, explain whether your injury or illness is likely to be covered, explain the time limits for filing claims in your state for cumulative trauma or occupational disease, and help develop the strong evidence needed to support a CT or stress-related claim.
Learn more about what a good workers’ comp lawyer should do.
]]>Some jobs are inherently more likely to lead to severe anxiety, but even jobs that don’t require exposure to traumatic events can result in mental or emotional injury.
While all mental health issues deserve to be taken seriously, not all are covered by workers’ compensation laws. Here's what you need to know about whether you can collect workers' comp benefits for a mental health condition.
Workers’ compensation laws governing psychological conditions vary from state to state. The majority of states offer limited coverage for mental health conditions under specific circumstances, such as when the psychological injury arises out of a work-related physical injury, or is caused by a stressor that is extraordinary or unusual in nature. An increasing number of states are also implementing or considering laws that provide workers’ comp coverage for PTSD claims by first responders.
Even if you are entitled to mental health coverage under your state’s law, obtaining workers’ comp benefits can be an uphill battle. Employers and insurers are often reluctant to compensate workers for psychological conditions because it can be hard to objectively measure these conditions or prove that they were caused by your job.
As a general rule, you’re more likely to recover workers’ comp benefits for mental health conditions in the following circumstances:
Your odds of recovering workers’ comp benefits are higher if your psychological condition stems from a work-related physical injury. For example, if you sustain a back injury while on the job, and suffer a depressive disorder as a result, you’ll likely be entitled to compensation for psychological injuries as well as for the original physical injury.
Many states don’t allow any workers’ comp recovery for mental health conditions unless they are tied to a physical injury. Even in states without such a law, it can be much easier to prove that mental health issues are work-related when they were caused by an on-the-job physical injury.
In an era of mass shootings, more and more states are instituting laws designed to protect the mental well-being of the firefighters, police officers, paramedics and other first responders who have to witness traumatic events as part of their job. At least a dozen states currently have laws allowing workers’ comp coverage for PTSD claims by first responders, and many more states are considering passing such laws. These laws allow benefits for purely psychological injuries that aren’t tied to any physical injury.
Some states, including Connecticut and New Mexico, have laws that apply only to certain types of first responders. Other states, such as Florida, allow recovery only when the first responders have witnessed a particularly horrific event. And a number of states have created a “rebuttable presumption” that a first responder’s mental health issues are an occupational injury, which means that workers don’t need to prove that their job caused their mental health issues. However, a workers’ comp insurer can still contest that assumption by demonstrating that there is a non-work-related cause for an employee’s psychological injury.
Some states provide workers’ comp benefits for employees who have suffered purely psychological injuries like PTSD, even if they’re not first responders.
In most of these states, however, the psychological injury must be the result of an extraordinary and unusual event or stressor. For example, in Colorado, mental health issues are compensable only if they are caused by a psychologically traumatic event that is generally outside of a worker’s usual experience. And in New York, workers can recover benefits for psychological injuries only if the injuries arise from abnormal stress and unprotected employer actions.
There are a few states that don’t impose this requirement. In California, for example, any employee may recover workers’ comp benefits for a purely psychological injury even if it wasn’t caused by an unusual, traumatic event, as long as the employee meets other requirements, such as being diagnosed with a mental disorder and proving that working conditions were at least 51% responsible for the disorder.
Just because you don’t qualify for workers’ comp benefits for a mental health issue doesn’t mean you have no legal remedies. There are other laws that may help provide the time and resources you need to recover.
You may be able to receive unpaid leave and job protection under the Family and Medical Leave Act (FMLA). If you meet the definition of “disability” under the Americans with Disabilities Act (ADA), you are entitled to accommodations from your employer so you can do your job despite your disability. And if you have a severe mental impairment that prevents you from going back to work, you may be entitled to Social Security disability benefits.
Because workers’ comp claims are often contested, they can be lengthy and complex. This is especially true for cases involving psychological injuries, as they are less straightforward than on-the-job physical injuries.
A workers’ comp lawyer can help you evaluate your claim, navigate the various stages of the process, and recover the benefits to which you're entitled. Most workers' comp attorneys charge a fee only if you win your case, and don't require any money up-front.
]]>Unlike a personal injury lawsuit, in which you generally have to prove that another person is at fault for causing your injury, workers’ comp is a “no-fault” system. This means that you can generally recover workers’ comp benefits even if you were at fault for causing your own injury, as long as your injury happened while you were working. For example, if you were in a hurry at work and disregarded a “wet floor” sign, then slipped and injured yourself, you’d probably still be able to recover workers’ comp benefits.
To receive workers’ comp benefits for a slip-and-fall injury, you need to report your injury to your employer, file a claim, and, if your claim is denied, appeal the insurance company's decision.
Workers’ comp laws vary from state to state, but in nearly all states, the first step in a workers’ comp claim is reporting your injury to your employer. Most states require that you do so within 30 days, and in some states, the reporting period is as short as three or four days.
While some slip-and-fall injuries are immediately apparent, others (such as head or soft tissue injuries) take a while to show symptoms, so it’s a good idea to report a fall even if you think you’re fine. A workers’ comp insurer is also less likely to be skeptical of your claim if you report your injury promptly. The report should include as many details as possible about what caused the fall, the body parts that were impacted, and any pain or dizziness you feel.
In addition to reporting your injury to your employer, most states also require you to file a claim with your state workers' comp agency. Your employer typically can provide you with the forms to file your claim. Your employer is responsible for filing the claim in some states.
How long do you have to file your claim? In many states, the deadline is 12 months. But in some states, the deadline is much shorter. Check the website of your state's workers' comp agency for more details.
The insurance company conducts an investigation to determine whether to approve your claim. If your claim is approved, you'll start to receive benefits. If your claim is denied, you have the right to appeal.
Appealing a workers' comp decision can be complicated and time-consuming. It often involves several proceedings, a settlement conference or mediation, and an independent medical examination. If these efforts to resolve the claim are unsuccessful, the case will be set for a formal workers’ compensation hearing.
In slip-and-fall cases, approximately 38% of employees who ultimately recover workers’ comp benefits initially had their claims denied, according to a Martindale-Nolo survey. After the initial denial, 45% had to file an appeal or request a workers' comp hearing before they received a settlement or award.
A common reason given for denial of a slip-and-fall claim is a worker’s preexisting condition. Insurance companies often blame back and neck injuries on the effects of aging, rather than on the workplace accident.
Because almost half of all successful workers’ comp slip-and-fall claims require an appeal, an experienced lawyer can make a big difference in whether you receive a settlement or award, as well as how much compensation you receive. A workers’ comp lawyer can prepare a legal analysis of your claim, negotiate for you at your settlement conference, represent you at your hearings, and make sure to comply with your state’s procedural rules and deadlines.
Hiring a workers' comp lawyer won't cost you anything out of pocket. In most states, workers' comp attorneys work on a “contingency” basis, meaning they charge a percentage of your benefits if you win your case, and nothing if you lose.
]]>Workers’ compensation covers injuries and illnesses that are within the “course and scope of your employment.” Most courts have interpreted this phrase broadly and erred on the side of covering injuries, to the benefit of employees making claims for benefits. In general, if you were engaged in an activity that benefits your employer, your injury will be covered.
If you are injured at your workplace while performing work duties, you will receive workers’ comp. For example, a dishwasher who slips and falls while working in a restaurant kitchen would be covered. .Injuries caused by repetitive work activities are also within the course and scope of employment. For example, if constant gripping and grasping at work causes carpal tunnel syndrome, you are eligible for workers’ comp. (To learn more, see our article on repetitive stress injuries in workers’ comp.)
If you are taking a break in your company’s break room or cafeteria, your injuries might still be covered by workers’ comp. In many states, it is considered a benefit to the employer when workers stay onsite for meal or rest breaks—because it saves time and because the employee remains accessible to the employer.
If you leave your workplace, you typically will not be eligible for benefits if you are hurt during your break, unless you are furthering your employer’s interests. For example, your injury will likely be covered if you were picking up boxed lunches for a meeting or you were having an off-site business meeting during lunch.
Most states cover injuries that occur at the workplace, even if you have clocked out for the day. This generally includes injuries that happen in a parking lot that is owned or controlled by your employer on your way to and from the building for work. However, once you’re done with work and leave the company’s premises, any injuries that happen are not covered.
If you are injured while you’re away from the workplace, your injury will be covered only if you were performing activities that benefited your employer. For example, courts have found injuries to fall within the course and scope of employment when they happen:
Every state has different rules for what qualifies as within the course and scope of employment. If you need help determining your eligibility for workers’ comp benefits, contact an experienced workers’ comp lawyer.
While every state has different workers’ compensation laws, there are some common situations where injuries are considered to fall outside the course and scope of employment. If any of these scenarios applies to you, contact a workers’ comp lawyer to find out more about your state’s workers’ comp laws and your eligibility for benefits.
If you are injured while commuting to and from work, the “coming and going rule” typically applies. Under this rule, travel to and from your fixed work site is not considered within the scope of your employment. For example, if you are hit by a car during your regular morning commute to the office, your injury will not be covered by workers’ comp.
On the other hand, your injuries will probably be covered by workers’ comp if you drive a company car, if you don’t have a fixed work site, or if you were running a work errand. For example, a traveling salesperson may receive workers’ compensation benefits if the salesperson was injured while driving from home to the first client meeting of the day. Likewise, an executive assistant who is injured while picking up the company president’s dry cleaning on the way into work would likely be covered.
Most workplaces offer team building and recreational opportunities for their workers. Depending on the circumstances, injuries at a social event—such as a company picnic, holiday party, or happy hour—might not be covered by workers’ comp. Certain factors make it more likely that the injury will be covered, including the following:
However, if an event is clearly voluntary and for the employee’s benefit only, the injury will usually not be covered by workers’ comp. Whether or not a claim is covered by workers’ comp is a very fact-specific inquiry. Do not assume that your injury isn’t covered by workers’ comp just because it happened at a company social event. (To learn more, see our article on company-sponsored events and workers’ comp.)
Most, if not all, state workers’ comp laws specifically exclude injuries caused by the worker’s own intoxication. For example, if you fall from a ladder because you’ve been drinking, your claim will probably be denied. If you have evidence that the accident was unavoidable or not your fault, you may still be eligible for benefits. For example, if you were working on a factory line, and another worker strikes you from behind with a lift truck, you may be eligible for benefits even if you were under the influence.
Some states—including Florida, North Carolina, Ohio, and Texas—assume that an injury is non-occupational if drug testing shows high levels of alcohol or drugs. However, intoxication defenses can still be difficult for employers to prove. If your drug and alcohol test was significantly delayed, it may not prove you were intoxicated at the time of the accident. (For example, a mildly positive marijuana test taken two days after an accident may be insufficient evidence.)
Intoxication-related injuries involve a detailed factual and legal analysis. Do not assume that you are ineligible for workers’ comp simply because you failed a drug test. An experienced workers’ comp lawyer may be able to prove that your injuries were within the course and scope of your employment.
Because horseplay and practical jokes are considered to fall outside of the scope of employment, related injuries are typically not covered by workers’ compensation. However, there are exceptions to this rule. For example, if your employer tolerated ongoing horseplay, your injuries may be covered. Likewise, if you were an innocent bystander, you will probably also still be eligible for benefits.
Similarly, most injuries caused by workplace fights or altercations are not covered by workers’ compensation. However, if the fight is over a work-related issue, you might still be eligible for benefits. For example, if you get into a fight with a coworker about your favorite sports team, it’s probably not a covered injury. But, if your coworker hits you after you complain about his or her poor job performance, you may be eligible for benefits.
Every state has different workers’ comp rules and exceptions (and exceptions to the exceptions). If your employer or its insurance company argues that your injury is not covered, you should contact an experienced workers’ compensation lawyer. A lawyer can evaluate your claim and tell you how likely you are to succeed on an appeal.
]]>Death benefits are intended to help compensate certain family members for the loss of financial support they had received from the deceased employee. While the exact eligibility requirements vary from state to state, death benefits are usually (but not always) reserved for those who were related to the deceased employee by blood or marriage—typically spouses, children, and other close relatives—who lived with and depended on the deceased employee for their living expenses. Certain states allow some benefits for relatives who were only partially dependent on the deceased employee.
There are different rules for deciding who qualifies as a dependent, depending on their relationship to the deceased employee and state law. Children under 18 are almost always considered dependents. The same goes for older children who have certain physical or mental disabilities that make them unable to earn a living. Several states also extend eligibility to children over 18 (up to 21 or 25) who are enrolled in qualifying educational or vocational programs.
Many states assume that spouses are dependents regardless of their own incomes. In other states, spouses won’t necessarily qualify if they earn over a certain amount of money, or they may have to prove their financial dependence no matter how much they earn.
For all other family members, eligibility is usually determined based on the specific circumstances and evidence in each case.
In order to receive death benefits, a work-related injury or illness must have caused or contributed to your loved one’s death. These benefits aren’t limited to situations where an employee dies on the job, such as in a serious workplace accident. Injured workers may die months or years later—although a few states don’t allow benefits for deaths that happened too long after the original accident. Death benefits may also be available when employees eventually die from illnesses they developed as a result of working conditions, like exposure to dangerous chemicals.
Even if your loved one had other medical conditions unrelated to work, you still may be eligible for death benefits if the work injury or occupational disease contributed to or accelerated the death. For example, you might be able to claim death benefits if a workplace accident aggravated your husband’s preexisting heart condition and led to his death.
Can Survivors Get Death Benefits After an Employee Dies of COVID-19?
When your family member has died of COVID-19—and you believe the disease resulted from workplace exposure—you may be wondering whether you can get death benefits. If the employer or its insurer already accepted a workers’ comp claim for COVID-19 while your family member was alive, and medical evidence shows that the death was a result of the disease, you should be eligible for death benefits as long as you meet the dependency qualifications discussed above. But if the employer denied the claim (or there wasn’t time to get through the claims process), you will likely face an uphill battle getting benefits—depending on where you live and the nature of the deceased employee's job. Several states have enacted measures that make it easier for first responders, healthcare workers, and other frontline workers to qualify for workers' comp benefits when they contract COVID-19, and for their survivors to get death benefits when the employees die of the disease. (Learn more about getting workers’ compensation benefits for COVID-19.)
Death benefits are often paid in regular installments. The amount of those payments is based on a percentage of what the employee used to earn before the injury. The percentage varies from state to state, but the typical weekly payment is two-thirds of the deceased employee’s average weekly wage, with maximum and minimum amounts.
Instead of installment payments, some states pay a one-time lump sum, usually representing two-thirds of the deceased employee’s wages for a certain period of time, such as two years. The lump sum is also generally subject to a minimum or maximum amount. Even in states that pay installment benefits, you may be able to negotiate a lump-sum settlement of your death benefits.
In some states, the total amount of death benefits is the same regardless of how many dependents there are. For example, the same total benefit amount may be divided among a surviving spouse and several dependent children. In other states, however, the benefit amount increases as the number of dependents increases.
If you’re also receiving survivors’ benefits through Social Security, there may be an offset that reduces your workers’ comp death benefits.
When death benefits are paid in installments, there are limits on how long those payments continue. In many states, surviving spouses receive benefits until their own death or remarriage. Children can typically receive death benefits until they turn 18, or in some cases, until they complete certain types of post-secondary education or vocational training. In other states, death benefits will stop after a certain number of weeks or a certain maximum dollar amount has been reached, regardless of the children’s age or the surviving spouse's remarriage.
In all states, workers’ comp pays at least a portion of funeral expenses for employees who've died as a result of their work injuries. There’s usually a maximum amount, which could be anywhere from a few thousand dollars to more than ten thousand dollars.
Workers’ comp also covers the medical treatment that the employee received before dying. In general, you shouldn’t be stuck paying remaining medical bills. However, the employee’s insurance company (or the state workers’ compensation agency) may review those bills to ensure that the treatment was necessary and related to the work injury or illness.
There are strict time limits for filing a claim for death benefits. In many states, the limit is one or two years from the date of death or the last payment of disability benefits. However, your state’s laws might have longer or shorter time limits. For that reason, it’s best to make a claim as soon as possible.
Because the workers’ comp rules for death benefits are complicated and vary from state to state, you should consider speaking with a workers’ compensation lawyer if you think you might qualify. These benefits can be an important financial resource for surviving dependents. But depending on your relationship with the deceased employee, you may need help proving that you relied on that person’s income or disability benefits to get by. An experienced workers’ comp attorney can explain how your state’s laws apply to your situation, how to make a claim for death benefit, and how to protect your rights in the process. And it's good to know that because of the way workers' comp lawyers charge for their services, the lawyer generally will receive only a limited percentage of the benefits you receive.
If your loved one already had a worker’s comp attorney, that’s a good place to start. Otherwise, you can use Nolo’s lawyer directory for a list of attorneys in your area.
]]>