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Workers’ Compensation: When Does It Cover Me?

Published in Workers Compensation on July 12, 2016.

Workers’ compensation benefits are to cover your medical expenses and help make up for lost wages from missed work as the result of a workplace injury. Most states have mandated workers’ compensation insurance policies that your company must purchase to protect your financial and medical well-being. In order to qualify for workers’ compensation benefits, you must fulfill two general criteria:

  • You must be an employee of a company that carries workers’ compensation insurance.
  • Your injuries must have occurred during the course of carrying out work-related duties.

The key word in this definition is “employee:” In order to qualify for workers’ compensation benefits, you must carry this classification. It doesn’t matter if you’re a seasonal, part-time, or temporary employee, you will still qualify for benefits. Independent contractors and freelancers, however, do not.

How Do I Know If My Illness or Injury Is Covered?

Almost every injury and illness is covered by workers’ compensation insurance – provided that it’s work-related. A case of the flu is not grounds for workers’ compensation benefits, unless you work with live flu virus samples as part of your work duties. Here are some other examples in which you may qualify for workers’ compensation:

  • You strain your back while lifting heavy boxes
  • You slip and fall on a slippery work floor
  • Your finger is caught in work machinery
  • You’re diagnosed with carpal tunnel as a result of typing frequently or you’re diagnosed with any other kind of repetitive stress injury

Even mental illness can count as grounds for workers’ compensation benefits if you’re part of a high-stress work environment, but these can be hard to prove.

An injury doesn’t necessarily have to occur at work to qualify for benefits. You might, for example, fall at an off-premises office function and still qualify for benefits. As long as you are performing work-related tasks, you’re eligible for compensation benefits.

What If I Was Acting Inappropriately?

Many wonder if they’re still eligible for workers’ compensation benefits, even if they were shirking their work duties or breaking the rules. There’s no clear-cut answer, but workers’ compensation benefits will cover you even if you’re not obeying every work rule. For example, if you neglect to wear appropriate protection and are injured using heavy machinery, you’re still eligible for benefits.

Workers’ compensation is a no-fault program, meaning you’re eligible for benefits even if the injury is your own fault. It won’t cover you, however, if you intentionally injure yourself or if you’re under the influence of drugs or alcohol. If you fall down a flight of stairs at an office party, you may be eligible for benefits, but if the reason you fell was because you were intoxicated, you may not.

The law is less clear on cases of horseplay. You may not be eligible for benefits if your actions were inappropriate: If your superiors foster this kind of atmosphere or condone goofy behavior, you may still be eligible for a claim.

Hiring a Workers’ Compensation Attorney

Are you having trouble getting your workers’ compensation claim approved? You need the advice and experience of an attorney. A lawyer can help you make a case for your claim and get you the benefits you need to make up for missed work. Lost wages, even for a week or two, can take a toll financially.

Let one of our experienced attorneys review your workers’ compensation case during our free initial consultation. Since we work on a contingency fee basis, you don’t pay anything unless we secure a settlement. To see if your workers’ compensation claim warrants legal action, get in touch with Nelson & Smith today.