Eligible Injuries and Illnesses
There are many common work-related injuries/illnesses for which you may file a workers’ comp claim:
- Lacerations
- Burns
- Lung damage from toxic fumes
- Pulled ligaments/muscles in knees due to heavy lifting or slip-and-falls
- Shoulder damage (torn rotator cuff, dislocation, or degeneration)
- Carpal tunnel syndrome from repetitive motion
- Fractured/broken/crushed bones due to falls or impact with heavy objects
- Complex regional pain syndrome (CRPS) and reflex sympathetic dystrophy (RSD)
- Any injury sustained in a company parking lot/structure before or after your shift
- Any injury sustained at a company-sponsored event you’re required to attend
- Any injury sustained in an accident when you’re driving a company car or your own vehicle in the course and scope of your job:
- Whiplash
- Spinal cord damage
- Paralysis
- Concussion
- Traumatic Brain Injury (TBI)
- Internal bleeding
- Organ damage
A normally compensable injury may not be covered, however, if it occurs under any of the following circumstances:
- You’re under the influence of drugs or alcohol at the time of the injury.
- You hurt yourself intentionally.
- You’re committing a crime or violating company policy when injured.
- You’re hurt while eating or picking up lunch outside the workplace and in your own car (unless your boss sends you to get food).
There are also some conditions that aren’t covered even if your company carries workers’ comp:
- Embolism
- Aneurism
- Stroke
- Heart attack
- Depression
- Stress
- Anxiety
- Post-traumatic stress disorder (PTSD)
Filing a Lawsuit Against Your Employer
If your employer carries workers’ comp insurance and you suffer a covered injury or illness in the course of performing your job duties, then filing a workers’ comp claim is your only recourse. You generally cannot sue your employer in such a situation. Workers’ comp exists, in part, to eliminate employees’ lawsuits against employers. You might, however, be able to file a suit against your employer if:
- Your company doesn’t carry workers’ comp insurance.
- You’re not eligible for workers’ comp benefits.
- Workers’ comp does not cover your particular illness/injury.
- Your employer has hurt you intentionally.
In any of these circumstances—or if your employer’s insurance company disputes your claim—an experienced workers’ comp attorney can examine the details of your case and recommend a sound course of action for fair compensation.
Third-Party Claims or Lawsuits
Even if you can’t sue your employer for your work-related injury/illness, in some cases you might sue a third party who was fully or partially responsible for your accident as long as that party is not your co-worker. The following scenarios are examples of situations in which you could have a third-party claim:
- You’re hurt in a work-related vehicle accident caused by a non-employee of your company.
- An outside janitorial service that cleans your workplace leaves a wet floor or some other hazard that causes you to slip and fall.
- Your accident is caused by defective equipment manufactured or maintained by an outside company.
- Your injury is caused by the negligence of a business or client you visit in the course of your work. (A dog bite at a client’s home or a slip and fall accident at a business location are examples.)
In such cases, your attorney can help you file an insurance claim or a lawsuit against the liable third party, from whom you might recover compensation for the remaining one-third of your wages and for your pain and suffering, which workers’ comp doesn’t cover.
Do You Need a Lawyer?
Not every workers’ comp case requires the help of an attorney. If your injury is minor, you don’t miss much work, and the insurance company accepts your claim, you could handle the workers’ comp process by yourself. You should consult a workers’ comp lawyer, though, under any of the following circumstances:
- Your injury/illness is serious and your medical bills high.
- You’ve sustained a total or partial disability.
- The insurance company is slow to approve necessary treatments.
- You’re dissatisfied with your company-recommended doctor.
- The insurance company disputes or denies your claim.
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