Workers’ Compensation: Qualifying Injuries and Illnesses

Becoming ill or getting injured while on the job can be overwhelming and in some cases life-changing. When this occurs, workers may be eligible for Workers’ Compensation benefits.

To claim benefits, you first need to understand whether your injury or illness is eligible for benefits. Below, the Cincinnati workers’ compensation lawyers at Young, Reverman & Mazzei provide an overview of basic eligibility for benefits, including the types of injuries and ailments that may be covered.

If you need help applying for workers’ compensation benefits or appealing a denied claim in Cincinnati, Ohio, Kentucky or Indiana, please call us today at 513-400-0000 or contact us online for a free consultation.

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The Job-Related Requirement

Although there are exceptions, most employers are required to provide workers’ compensation insurance for their employees.

In general, any injury or illness that occurs while you were performing your job duties will be covered under your state’s workers’ compensation system. As long as your injury is job-related, it should be covered regardless of fault.

The injury or illness does not have to occur at your place of work. It only has to occur while you were performing your job duties.

If you’re injured at work, you should notify your employer as soon as possible and seek medical attention right away. Depending on where you live, the process to receive workers’ compensation benefits will vary. Ohio, Kentucky and Indiana share common requirements for determining whether an illness or injury is work-related, but their claim processes differ:

• Ohio: You have up to two years from the date of a work-related injury to file a formal claim with the Ohio Bureau of Workers’ Compensation (BWC). You must choose a BWC-certified doctor for care. Finally, your employer’s insurance carrier will decide whether to pay out benefits. If you’re denied, you can file an appeal and request a hearing.
• Kentucky: Kentucky also allows you two years from the date of an injury to file a claim with the Kentucky Department of Workers’ Claims (DWC). Depending on your employer, you may have to see a specific doctor; if your employer doesn’t have a managed care program, you can choose your own. Unlike many other states, Kentucky allows workers to waive their workers’ compensation rights if they choose to sue their employer instead.
• Indiana: Within 30 days of an injury at work, you must give notice to your employer. Your employer sends a report of injury form to its insurance company, who then files a report with the Workers’ Compensation Board of Indiana. You must also see a doctor chosen by your employer.

Types of Work-Related Injuries or Illnesses

To file a workers’ compensation claim and receive benefits, you must prove that your injury or illness is work-related. This is commonly described as “arising out of employment and occurring during the course of employment,” or AOE/COE.

Types of illnesses or injuries that are usually covered by workers’ comp include:

Work-Related Accidents

Examples include breaking a bone in a slip-and-fall accident or suffering a burn while working.

Repetitive-Stress Injury Or Cumulative Trauma

Repetitive actions that contribute to an injury over time can be covered by workers’ comp. Examples of repetitive stress injuries include carpal tunnel syndrome, hearing loss, and back sprains from repeated lifting and carrying.

Occupational Diseases

Exposure to certain chemicals or elements in the workplace can lead to certain conditions or illnesses. Examples include coal workers’ black lung disease (CWP), which is common in Kentucky and caused by long-term exposure to coal dust. More recently Ohio has seen a rise in mesothelioma, a type of cancer caused by asbestos exposure at jobs from as far back as the 1980s.

Pre-Existing Conditions

If you have a pre-existing condition that is aggravated by your work, it’s possible to receive workers’ comp benefits. For example, if you had a previous injury like tendonitis and subsequently exacerbated it while pushing or pulling something heavy at work, workers’ compensation may cover this injury.

Injuries and Illnesses Not Covered by Workers’ Compensation

Your ailment may not be covered by workers’ compensation if:

• Your injury is minor and treatable with basic first aid. Examples include small cuts, scrapes or headaches.
• Your injury occurred on the way to or from work. Also called the “going and coming rule,” injuries that occur during lunch breaks or commutes to and from work are typically not covered. However, there are exceptions if you are driving a company vehicle, traveling on a business trip, running errands for your boss, or travel is a regular part of your job description.
• Your injury was caused by misconduct. If you were engaging in horseplay, breaking a workplace safety rule, trying to hurt someone else or yourself, breaking the law, or using drugs or alcohol at the time, it’s likely not covered by workers’ comp.

Legal Help for Injured Workers in Ohio, Indiana and Kentucky

The workers’ compensation benefits process can be complicated and frustrating, especially as you’re trying to recover from an injury.

Although you are not required to hire an attorney to file a workers’ compensation claim, a knowledgeable lawyer can relieve some of the stress you feel while fighting for maximum benefits. The personal injury attorneys at Young, Reverman & Mazzei have been helping injured workers and their families get the financial benefits they need since 1972.

To learn if you’re eligible for workers’ compensation benefits, or if you need help appealing a denied claim, please call us today at 513-400-0000 or contact us online to schedule your free consultation.

In Ohio, we serve clients from the greater Cincinnati and Dayton areas. We also welcome clients from Dearborn County in Indiana and Campbell County, Boone County and Kenton County in Kentucky.