Which Injuries Are Covered By Workers Compensation Benefits

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When an employee is injured on the job, he or she may be entitled to workers' compensation benefits. Some limiting factors determine who may qualify, and what types of injuries may be considered compensable.

Workers' compensation insurance is a type of insurance that provides restitution for medical care, and compensation for lost wages, for employees who become injured while in the place of employment or while performing the duties of their job, even if it is off the premises. In exchange for the guarantee of income and medical treatment in the event of injury or illness, the employee forfeits their right to sue the employer under the umbrella of negligence. Plans fluctuate according to different state court districts, though they can be made for weekly payments instead of wages as a type of disability insurance, compensation for past and future economic losses, the payment or reimbursement of the medical expenses as a type of health insurance, and benefits payable to the depends of workers who were killed as a type of life insurance.

Individual state laws determine which employers are required to provide workers' compensation insurance coverage for their employees. Some states provide exemption for very small businesses, such as those who might employ household staff or seasonal farm hands, or any business that has fewer than a specified number of employees.

For those employers required to provide insurance, most injuries are covered without the need to determine who is at fault, even if an accident is caused through carelessness. However, most states do not hold an employer responsible to pay for injuries that result from an employee's participation in an illegal or expressly prohibited activity. Employees who are injured while under the influence of alcohol or drugs, while in the process of committing a crime, or who intentionally caused the injury through horseplay or self-infliction, would not likely be eligible for compensation.

Injuries that are work-related do not necessarily have to occur on the employer's premises in order to be considered compensable. An employee injured while traveling at the request of, or for the purpose of, the employer may be eligible for benefits. Likewise, an employee injured at a social event where his or her employer required attendance may be covered by the worker's compensation insurance. A person is also eligible for workers compensation if they have been injured during a lunch break.

Regardless of where an accident or occupational exposure occurs, the time guidelines for reporting a work-related injury are the same as for incidents occurring on the employer's property. Not adhering to the reporting rules will affect eligibility for, or level of, compensation.
Some types of injuries that are covered are those that are caused by lifting heavy equipment, the use of equipment that hasn't been inspected or is defective, explosions, fires, and slipping on a surface that is wet or oily.

Additionally, some employers assume strict liability for activities that are not directly related to the job or specifically required, but may be considered a desirable aspect of employment. Some firefighters and police officers, for example, may be covered by workers' compensation if injured while participating in physical fitness training as a necessary component of their employment, even if the activity is done at a private facility and on the employee's own time. Most employers who agree to this type of coverage require that the employee file letters of intent stating specifically the nature of the activity and where and when it will be completed.

As with all aspects of the workers' compensation laws, the specifics of coverage may vary somewhat from state to state. It is best to consult individual state laws, or a qualified workers' compensation attorney, if you have questions about personal injury on the job or if you have been injured while working or performing another work-related service.


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