Can You Count On Workers’ Compensation Coverage When You Need It?

Posted on: 24 September 2021

Many workers assume that their employer's workers' compensation insurance will cover them for almost any sort of work accident. However, like almost all types of insurance, the details reveal that coverage is not a guarantee. Read on to find out when you can count on coverage and when that coverage might not happen.

You Can Probably Count on Coverage

Certain situations are more likely to result in workers' comp coverage than others. Take a look at this listing of common work-related medical issues below that are usually covered.

  • Body injuries that happen during working hours.
  • Occupational illnesses acquired at work. Exposure to dangerous chemicals or substances at work may cause respiratory illnesses, for example.
  • Some mental health conditions may be covered if the claimant can prove it's work-related. For example, PTSD (post-traumatic stress disorder) may be covered in certain situations in which the employee suffered from a sudden, traumatic incident at work.
  • Slow-to-show injuries like carpal tunnel syndrome may be covered.
  • Certain injuries occurring off the job site but are closely related to work. That might include business travel situations, off-site job training, etc.
  • Surprisingly, some preexisting conditions may be covered under workers' comp rules if the claimant can show that it was made worse due to work. For example, if you are being treated for heart disease, you may be covered if you have a heart attack as a result of a very stressful job.

Coverage May Be Denied

Conversely, there may be some situations where you could be denied coverage. Here are a few examples:

  • The below situations may not be covered but you should speak to a workers' comp lawyer before you miss out on filing a claim and gaining benefits.
  • The employee is found to be under the influence of drugs or alcohol at the time of the incident. If you were prescribed the drugs in question or you know you were not inebriated, speak to a workers' comp lawyer at once.
  • Intentional or self-inflicted injuries are not usually covered. This type of situation can be difficult to prove so speak to a lawyer about the claim if it's denied.
  • In some cases, employees who are violating safety, health, or other rules set forth by the employer may not be covered when it results in an injury. For example, if you are required to wear ear protection while on the job and you don't, you may not be eligible for benefits when you suffer from hearing loss.
  • In the rare instance that you are injured at work while also committing a crime, you may not be covered from any resulting injuries.

Any time you are denied coverage, don't just assume you have no options. Speak to a workers' compensation lawyer and get the help you need with your claim.