If you are seeking workers' compensation benefits, you will have to show that your injury or illness is work-related. 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. (See Nolo's article, Are You Eligible for Workers' Comp Benefits? for more on these requirements.)
Although the "work-related" requirement may seem like a simple rule, it can get tricky. Some common situations are covered below. If your injury or illness falls into a gray area, you may want to consult with an attorney to find out whether you will be eligible for benefits. (To learn about situations that aren't covered by workers' compensation, see Nolo's article, Workplace Injury: When You Can Sue Outside of Workers' Compensation.)
Usually, injuries or illnesses that happen on an employee's lunch break are not covered under workers' compensation. For example, if you sprained your ankle while walking into a deli to pick up your lunch (or lunch for your coworkers), then you probably cannot claim workers' compensation for that injury. However, if you were also picking up lunch for your boss, then the injury might be covered.
If you sprained your ankle in a cafeteria on the company's premises, then your injury might be covered by workers' comp. Using a company cafeteria saves you time, which leaves more time for work, which makes your use of the cafeteria beneficial to your employer.
Many companies sponsor special events like parties, picnics, or baseball games -- and injuries sustained at these events -- are usually covered by workers' compensation. For example, let's say Don drinks too much wine at the company anniversary party and decides to twirl his coworker Angie above his head while they are dancing. Unfortunately, he drops Angie, and they both fall. Angie breaks her arm, and Don suffers a severely strained neck. Both injuries are probably covered by workers' compensation.
If you are injured on your commute to or from work, your injury probably isn't covered by workers' compensation. However, there are many times when injuries during travel are covered. For example, if you are traveling for work, but not to your fixed work site (on a business trip, for example), then your injuries will probably be covered. If you are a traveling salesperson with no regular work site, then injuries you sustain while driving to meet with a customer will probably be covered. Or, if you are injured during your regular commute but are driving a company vehicle, then your injuries will probably be covered.
If you were injured while breaking a workplace safety rule or while doing something else that your employer has prohibited (even a criminal act), your injury may still be covered by workers' compensation, depending on the level of your misconduct. 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' compensation, regardless of fault.
As an example of how injuries that stem from misconduct are usually still covered under workers' compensation, let's say Dolores and Kalil work on the assembly line at Widget World. One day, they decide to play catch with a two-pound metal ball that is part of the machinery. This is in direct violation of a safety rule, which prohibits playing with the equipment. While Dolores is attempting to catch the ball, it slips through her hands and hits her in the head, knocking her unconscious and causing a minor brain injury. Her injury could still be covered by workers' compensation, even though she was violating a work rule when she got hurt, especially if the employer knew this type of horseplay occurred and condoned it.
There are some exceptions to this general rule. For example, if your injuries were self-inflicted, then they might not be covered.
If you have a preexisting condition, and your job aggravates or exacerbates it in a way that results in an injury or illness, then the injury is probably covered by workers' compensation. For example, when Marco was 30, a disc in his back ruptured. The injury resolved itself within six months and has not bothered him since. He is now 45 and works in a department store. One day, he ruptures the same disc while lifting a heavy object off a shelf. Although his job did not cause his initial injury, it certainly caused it to reoccur. The injury is likely covered by workers' compensation.
People who work in noisy environments -- such as construction sites or manufacturing plants -- often suffer hearing loss over time. Unless there is some other obvious reason for the impairment, this injury is usually covered by workers' compensation.
Mental conditions that are job-related are covered by workers' compensation. For example, if you are traumatized by witnessing another employee injured or killed on the job, your trauma is compensable by workers' comp. Conditions caused by a stressful workplace environment can also be compensable. In addition, if you become depressed because you have suffered from a workplace injury, that depression is covered by workers' compensation.
Be warned, however, that it can be hard to prove that the mental condition actually exists and that it was caused by workplace events. This is a situation in which a consultation with a lawyer can help you decide how to proceed. To locate a workers' compensation attorney in your geographic area, visit Nolo's Lawyer Directory.
Diseases and Illnesses
If you have a disease or illness resulting from your work, then you are entitled to workers' compensation. For example, workers suffering from asbestosis, which is a disease caused by exposure to asbestos, can receive workers' compensation benefits, as can workers suffering from black lung disease, which is caused by inhaling coal dust. Except in the case of recognized environmental illnesses like these, however, it can be difficult to prove that a disease is work-related and not something that would have happened anyway.
For More Information
For more information on workers' comp, see Nolo's article Types of Workers' Comp Benefits, or if you were injured in California, see the book California Workers' Comp, by Attorney Christopher Ball (Nolo).