Injuries and Illnesses Covered by Workers' Compensation

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Workers’ compensation provides a claim and benefit system for workers who become ill, are injured, or die on the job.

Injuries

To be covered by workers’ compensation, an injury need not be caused by a sudden accident (such as a fall or equipment malfunction). Equally common claims are for injuries due to repeated physical motions—backstrain from lifting heavy boxes, for example. Physical conditions that are aggravated by workplace conditions—such as emphysema made worse by airborne chemicals -- may also be covered. And, workers can sometimes be compensated for the effects of psychological stress caused by the job.

With a few exceptions, any injury that occurs in connection with work is covered. The legal boundary is that employees are protected by workers’ comp as long as the injury happened “in the course of employment.” For example, a computer repair technician would be covered by workers’ comp while making service calls to customers, but not while traveling to and from work or going to a purely social dinner later that evening.

From the employee’s standpoint, workers’ comp is a no-fault system. It does not matter whether a worker was careless when injured, although claims made by employees who hurt themselves while drunk or fighting have traditionally been rejected as outside the bounds of “work-related activity.” Some states restrict coverage for injuries caused by employees’ own “willful misconduct”—a term given differing spins by differing courts. And a number of states expressly restrict or deny benefits when an employee’s claim is based on injuries caused by the use of nonprescription, illegal drugs.

Injuries that can be shown to have been intentionally self-inflicted by the employee, or to have been caused by substance abuse, generally are not covered. However, courts have often sided with the injured worker when such cases are disputed, ruling that the injury is covered as long as the employee’s behavior was not the only thing that caused the injury. Another questionable area is injuries caused by a coworker’s violent behavior, although the workers’ comp laws in a few states, including California, specifically cover them.

The legal definition of when you are working, for workers’ compensation purposes, also has expanded in recent years to cover a greater number of injuries. For example, employees who were injured playing baseball or football on a company-affiliated team have been allowed to collect workers’ compensation benefits for those injuries.

Which Injuries Are Work-Related?

One of the most dramatic expansions of the definition of work-related illness occurred in a 1990 Michigan appeals court ruling. In that case, a brewery worker was found eligible for workers’ compensation benefits because his tendency toward alcoholism—he typically drank 15 to 20 bottles of beer at work each day, and more at home—had been made worse by the fact that his employer gave employees free beer to drink during their breaks. (Gacioch v. Stroh Brewery Co., 466 N.W. 2d 302.)

However, the courts do set some limits, as demonstrated by a California case. There, a workers’ compensation claim was filed by a lawyer who fell off his bicycle while pedaling to a weekly meeting of workers’ compensation attorneys. He argued that, because he is a lawyer, much of his work involves thinking and analyzing. And because “his office is in his head,” he claimed he should remain covered by workers’ comp around the clock.

In rejecting the claim, the workers’ comp board referee injected a bit of common sense: “Would claimant be covered if he woke in the middle of the night with an idea regarding a case and injured himself falling out of bed to write it down?” he asked. “Common sense tells me that the employment relationship, no matter how all-consuming it may appear to the claimant, must have limits. When claimant fell from his bicycle ... while thinking of client calls to be made, he was pedaling beyond those limits.” (WCB Case No. 90-18674.)

For more on this distinction, see Workers' Compensation: Is Your Injury or Illness Work-Related?

Injuries Caused by Repetitive Motion

In a typical year, more than six million work-related injuries and illnesses occur in the United States. The most rapidly growing category of workplace injuries is caused by repetitive motions of the body. These occupational pains go by many names and acronyms, including repetitive stress injuries (RSIs), cumulative trauma disorders (CTDs), and repeated motion injuries (RMIs).

When they primarily afflict the wrists, hands, and forearms, these injuries are called carpal tunnel syndrome—the bane of office workers who spend their days in front of computer terminals. Many other parts of the body are susceptible to injury when used repeatedly to perform motions beyond the specifications for which nature designed them. Our bodies were simply not made to withstand the demands of making the same motion thousands of times in a short time period—especially if we don’t want to. A recent study found that employees who were dissatisfied with their jobs were most likely to develop repetitive stress injuries.

Typical symptoms of repetitive stress injuries include swelling and redness near bone joints; extreme sensitivity to movement and external touch; pain, both sharp and dull, in the overused area that may radiate into other parts of the limb, abdomen, head, or back; and numbness of the affected body part or those near it. If detected early, injuries caused by repeated motions can often be cured by a short period of rest, light medication, and rehabilitative exercise. The most serious cases, however, can escalate to lifelong physical disabilities.

Work-related cumulative motion injuries are typically covered by workers’ compensation insurance. But the best workers’ compensation claim is the one that you never have to file, so here are a few of the steps that health experts recommend to avoid these injuries:

  • Take frequent, short breaks from repetitive, physically stressful work whenever possible. This allows your muscles and joints to recover a bit from unnatural tensions that may result from your work.
  • Do gentle stretching exercises at work regularly, paying particular attention to the parts of your body that you use most often. This reduces the muscle tightening that contributes to the problem.
  • Watch for early symptoms, such as stiffness or other discomfort in heavily used body parts. Complete recovery is much more likely if the symptoms are recognized early.
  • Redesign your work tools or your work position and movements—or ask your employer to help do so. Good redesign examples are wrist rests for use with personal computer keyboards and ergonomic office furniture.
  • Remember that heart-pounding physical exertion is not necessary for dangerous body stress to occur. Just as you can wake up with a sore shoulder after sleeping all night, you can suffer a muscle or tendon injury even in jobs that involve very limited exertion.

Stress-Related Injuries

Illnesses that are the gradual result of work conditions—for example, emotional illness and stress-related digestive problems—increasingly are being recognized by the courts as covered by workers’ compensation insurance. Perhaps not coincidentally, such stress injury claims are on the rise, too.

The American medical profession, traditionally slow to acknowledge the interworkings of mind and body, no longer ignores the effects of job-related stress on general health. According to the American Institute for Preventative Medicine, stress is at the root of nearly two-thirds of all office visits and plays a major role in heart disease and cancer. Currently, only about half the states recognize stress as a valid basis for workers’ comp claims. But, in every state, if you show that stress has reached the level of a disability, your employer must accommodate your work to your condition—by reducing work hours or providing a quieter atmosphere, for example. 

Illnesses

An illness becomes an occupational illness—and is covered under the workers’ compensation system—when the nature of a job increases the worker’s chances of suffering from that disease. In fact, in some states, certain illnesses (such as heart attacks and hernias) are presumed to be covered for high-stress jobs such as police work and firefighting. There must, however, be a clear connection between the job and the illness. Also, in examining a claim, investigators will look into nonwork factors—such as diet, exercise, smoking and drinking habits, and hobbies—that may affect or aggravate a particular condition.

Death

Dependents of a worker—usually a spouse, children, or other family members—who is killed on the job or die as a result of a work injury or illness are almost always eligible to collect workers’ compensation benefits.

Even if an employee is found dead in the workplace, no one witnessed the death, and no cause of death is obvious, the death is usually covered by workers’ compensation. The possibilities of suicide or murder are usually ignored by courts unless there is strong evidence that the death qualifies as one or the other.

by: Barbara Repa

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