Injuries and Illnesses Covered by Workers' Compensation

You may be able to receive workers’ comp benefits for a range of medical conditions including repetitive strain, cumulative trauma, occupational illness, and problems caused by job stress.

Employees who are injured or become ill in connection with their work may be eligible for workers’ compensation benefits. 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. In fact, these "cumulative trauma" (CT) injuries represent the most rapidly growing type of workers’ comp claims. The Workers’ Compensation Insurance Rating Bureau of California reported that workers’ comp claims involving cumulative trauma more than doubled between 2007 and 2015, to nearly one-fifth of all claims in that state.

The First Hurdle: The Work-Related Requirement

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 U.S. Occupational Safety and Health Administration, 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.

Repetitive Motion and Overuse Injuries

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.

Occupational Illnesses

Workers’ compensation generally covers illnesses or diseases that employees develop over time 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 AIDS/HIV contracted when a health worker gets a needle stick or a porn actor is forced to work without a condom.

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.

Pre-Existing Conditions

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.

Hearing Loss

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.

Stress-Related Injuries

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. Ann. § 23:1021).

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 at least 51% responsible for their psychiatric injuries (Cal. Labor Code § 3208.3).

Stress Resulting from Work-Related Physical Injuries

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.

When Employees Are Partly at Fault for Work-Related Injuries and Illnesses

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 an Employee Dies Because of Work Injury or Illness

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.

Speaking With a Lawyer

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.)

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