Workers' compensation is an important safety net for employees who suffer injuries or illnesses on the job. Knowing what injuries are covered by workers' compensation is necessary for both employers and employees to make sure that workers receive the benefits they deserve. From smaller permanent injuries to more serious conditions like a catastrophic injury, workers' compensation brings a number of protections designed to assist injured workers in their recovery process, and to compensate them should they suffer a significant and permanent injury.
The Basics of What Injuries Are Covered By Workers' Compensation
Workers' compensation is in place to cover injuries and illnesses arising out of the course of the employment. This means any injury that occurs while performing job-related duties may be eligible for coverage. But knowing what injuries are covered by workers' compensation requires a closer look at the different types of injuries and the specific circumstances under which they occur.
Common Types of Injuries Covered
Physical Injuries from Accidents
Physical injuries from accidents are among the most common types of injuries covered by workers' compensation. These can include anything from broken bones and fractures to significant burns and cuts. While the insurance carrier for the employer is responsible to provide treatment, and to pay temporary disability benefits for time out of work, they are only responsible to compensate workers should they be able to prove that their injuries are significant and permanent in nature to receive financial compensation.
Whether the injury is caused by a fall, machinery malfunction, or any other workplace hazard, it usually falls under the umbrella of what injuries are covered by workers' compensation.
Repetitive Stress Injuries
Repetitive stress injuries (RSIs) are another category of injuries frequently covered by workers' compensation. These injuries develop over time because of repetitive motions or strain on certain parts of the body. The injured worker needs to prove that the work effort is greater than that of ordinary life.
Carpal tunnel syndrome, tendinitis, and others are examples of RSIs that workers' compensation might cover. These injuries can be just as debilitating as acute injuries and sometimes require long-term treatment and rehabilitation.
Occupational Illnesses
Besides physical injuries, workers' compensation also covers illnesses that develop as a result of workplace conditions. These are known as occupational illnesses and can include respiratory conditions from exposure to toxic substances, skin diseases from contact with harmful chemicals, and even cancers.
The big factor in determining whether an illness is covered whether the work exposure was a significant contributing factor in the development of the disease or condition resulting in a permanent loss of function.
Catastrophic Injuries
A catastrophic injury is one that is so severe it results in permanent disability or greatly impairs the injured worker's ability to earn a living. Examples include traumatic brain injuries, spinal cord injuries leading to paralysis, and severe burns.
These injuries are not only life-altering but also require extensive medical treatment, rehabilitation, and long-term care. Workers' compensation provides coverage for these serious injuries, including temporary disability benefits while the injured worker is out of work, reasonable and necessary medical care through authorized treating doctors, and permanency benefits.
Injuries Not Covered by Workers' Compensation
Although the topic of what injuries are covered by workers' compensation is expansive, there are specific scenarios where an injury might not be eligible for coverage. Knowing these exclusions is important for both employers and employees. In short, if the injury is not permanent, the employer may only be responsible for sending the worker to doctors, and paying for temporary disability benefits, but not any permanency benefits (if the injury is not permanent).
Injuries from Horseplay or Misconduct
If an employee is injured while involved in horseplay, misconduct, or activities that are outside the scope of their job duties, workers' compensation does not cover the injury. For example, if a worker is injured while goofing around with machinery or during a non-work-related fight with a coworker, these injuries are likely to be excluded from coverage.
Self-Inflicted Injuries
Injuries that are self-inflicted, whether intentional or due to reckless behavior, are usually not covered by workers' compensation. This includes situations where an employee deliberately harms themselves or is involved in dangerous behavior that leads to injury. These cases are typically very fact-specific.
Injuries Sustained Off-Site
Injuries that occur off the employer's premises or outside of work hours are usually not covered by workers' compensation. But there are exceptions, as with injuries sustained while performing work-related tasks off-site or during business travel. The specific circumstances of the injury will help figure out whether it is covered.
The Part Played by Workers' Compensation Attorneys
Dealing with the complexities of what injuries are covered by workers' compensation can be tough, especially when disputes arise regarding the eligibility of a claim. This is where workers' compensation attorneys play a major role. These legal professionals specialize in helping injured workers know their rights, gather necessary evidence, and advocate on their behalf to make sure they receive the benefits they deserve.
Workers' compensation attorneys can assist in any number of situations, such as when a claim is denied, when there is a disagreement about the extent of the injury or the required medical treatment, and the nature and extent of any permanent injury.
The Process of Filing a Workers' Compensation Claim
Knowing the process of filing a workers' compensation claim is highly recommended so injured workers receive the benefits they are entitled to. After sustaining a workplace injury, the first step is to report the injury to the employer as soon as possible. Prompt reporting matters, because delays can lead to complications or even denial of the claim. As importantly, if not more so, a Claim Petition must be filed with the Division of Labor within two-years from the last date of benefits provided by the employer or their insurance. This is known as the State of Limitations. If no claim is filed with the Division of Labor within this time, the injured worker would be forever barred from seeking any relief from the Court. If the employer’s insurance refuses to provide benefits, then the injured worker has two-years from the date of the injury to file the claim with the Court. Keeping track of the Statute of Limitations is incredibly important for the injured worker as it is the one thing that can not be fixed by a Judge.
However, in most cases, once the injury is reported, the employer is responsible for delivering the necessary forms and information to the injured worker to begin the claims process with the insurance company. It is important for the injured worker to complete all forms accurately and provide any required documentation, like medical records or witness statements, to support their claim.
The employer then submits the claim to their workers' compensation insurance provider, who will review the claim and determine whether it is eligible for benefits. If the claim is approved, the injured worker will begin receiving benefits, which may include coverage for medical expenses, temporary and permanent disability benefits.
However, the insurance company does not make the final determination of whether a claim if compensable or not – this is up to a New Jersey Judge of Worker’s Compensation. At Levinson Axelrod, we have 85-years of experience in advocating for our clients to get them the benefits that they are entitled.
Getting Coverage for Your Injury
Realizing what injuries are covered by workers' compensation is imperative to make sure that workers receive the support they need after a workplace injury. From smaller injuries to catastrophic injuries, workers' compensation brings a safety net to help injured workers recover and return to their lives.
But dealing with the complexities of workers' compensation claims can be difficult, which is why it's best to get the guidance of experienced workers' compensation attorneys.
At Levinson Axelrod, P.A., we have been fighting for injured workers across New Jersey for over 85 years. Our dedicated team of attorneys knows the intricacies of workers' compensation law and is committed to helping you secure the benefits you deserve.
Whether you're dealing with an injury that happened at work, we are here to guide you through every step of the claims process.
Call us today at (732) 440-3089 or use our online form to reach out for a FREE consultation. Let us help you work through your workers' compensation claim and make certain your rights are protected.