Is my injury covered by work comp insurance? – II

Published on Nov 8, 2016 at 8:27 pm in Workers Compensation.

In a previous post, we discussed how even though the possibility of suffering serious work injuries is the last thing on the minds of most employees, they nevertheless occur on a regular — and somewhat stunning — basis.

We also discussed how employees should take some comfort from the fact that their employer more than likely has workers’ compensation insurance and how state law provides a rather precise definition of who exactly is eligible for work comp benefits. Specifically, if the harm endured by the injured worker was the result of an “accidental personal injury arising out of and in the course of employment,” the work-related injury should be covered.

While this seems like a rather basic definition, each phrase in this statutory language has a precise meaning that must be met in order for a person to be considered entitled to work comp benefits.

The threshold requirement that must be satisfied is that a person must actually be an employee or, in other words, there must be a genuine employer-employee relationship.

Under the state’s workers’ compensation statute, this essentially means those individuals treated as independent contractors, or working as part of either a partnership or a sole-proprietorship are not entitled to work comp benefits.

If an employer-employee relationship does exist, the next inquiry is whether the injury was actually the result of an accident, meaning it happened purely “by chance or without design, taking place unexpectedly or unintentionally.”

While this is a straightforward determination, it’s important to note that occupational diseases, meaning those serious illnesses caused by the nature of an employee’s job, serve as an exception to this specific accident requirement.

By way of example, consider workers who develop mesothelioma after years of asbestos exposure, or skin diseases caused by years of exposure to harsh chemical solvents.

We’ll continue this discussion in future posts, taking a closer look at what the terms “arising out of employment” and “arising in the course of employment” mean under state law.

In the meantime, consider speaking with a skilled legal professional to learn more about your rights and your options if you have been injured on the job and the insurance company has denied your claim for work comp benefits.



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