If you are seeking workers' compensation benefits, you will have to show that your injury or illness is work-related. Usually, if you were doing something for the benefit of your employer, and you were injured or became ill as a result, then your injury or illness is work-related and you can receive benefits as long as you meet the other eligibility requirements.
Although the "work-related" requirement seems simple, it can get tricky. Some common situations are covered below. If your injury or illness falls into a gray area, you may want to consult with an attorney to find out whether you will be eligible for benefits.
Typically, injuries or illnesses that happen on an employee's lunch break are not covered under workers' compensation. For example, if you sprained your ankle while walking into a deli to pick up your lunch (or lunch for your coworkers), then you probably cannot claim workers' compensation for that injury. However, if you were also picking up lunch for your boss, then the injury might be covered. If you sprained your ankle in a cafeteria on the company's premises, then your injury might be covered by workers' comp.
Company EventsMany companies sponsor special events like parties, picnics, or baseball games -- and injuries sustained at these events are usually covered by workers' compensation. For example, let's say To drinks too much wine at the company anniversary party and decides to twirl his coworker Kari above his head while they are dancing. Unfortunately, he drops Kari, and they both fall. Kari breaks her arm, and Tom suffers a strained neck. Both injuries are probably covered by workers' compensation.
TravelIf you are injured on your commute to or from work, your injury probably isn't covered by workers' compensation. However, there are sometimes when injuries during travel are covered. For example, if you are traveling for work, but not to your fixed work site (on a business trip, for example), then your injuries will probably be covered. If you are a traveling salesperson with no regular work site, then injuries you sustain while driving to meet with a customer will probably be covered. Or, if you are injured during your regular commute but are driving a company vehicle, then your injuries will probably be covered.
MisconductIf you were injured while breaking a workplace safety rule or while doing something else that your employer has prohibited (even a criminal act), your injury may still be covered by workers' compensation, depending on the level of your misconduct. This is part of the workers' compensation bargain: Employees do not have the right to sue their employer for work-related injuries, but those injuries are usually covered by workers' compensation, regardless of fault.
As an example of how injuries that stem from misconduct are usually still covered under workers' compensation, let's say Ann and Lee work on the assembly line at Widget World. One day, they decide to play catch with a two-pound metal ball that is part of the machinery. This is a direct violation of a safety rule, which prohibits playing with the equipment. While Ann is attempting to catch the ball, it slips through her hands and hits her in the head, knocking her unconscious and causing a minor brain injury. Her injury could still be covered by workers' compensation, even though she was violating a work rule when she got hurt, especially if the employer knew this type of horseplay occurred and condoned it.
There are some exceptions to this general rule. For example, if your injuries were self-inflicted, then they might not be covered.
Preexisting ConditionsIf you have a preexisting condition, and your job aggravates or exacerbates it in a way that results in an injury or illness, then the injury is probably covered by workers' compensation. For example, when Bill was 30, a disc in his back ruptured. The injury resolved itself within six months and has not bothered him since. He is now 45 and works in a department store. One day, he ruptures the same disc while lifting a heavy object off a shelf. Although his job did not cause his initial injury, it certainly caused it to reoccur. The injury is now covered by workers' compensation.
Hearing LossPeople who work in noisy environments -- such as construction sites or manufacturing plants -- often suffer hearing loss over time. Unless there is some other obvious reason for the impairment, this injury is usually covered by workers' compensation.
Mental ConditionsMental conditions that are job-related are covered by workers' compensation. For example, if you are traumatized by witnessing another employee injured or killed on the job, your trauma is compensable by workers' comp. Conditions caused by a stressful workplace environment can also be compensable. In addition, if you become depressed because you have suffered from a workplace injury, that depression is covered by workers' compensation.
Be warned, however, that it can be hard to prove that the mental condition actually exists and that it was caused by workplace events. This is a situation in which a consultation with a lawyer can help you decide how to proceed.