Qualifying for Workers’ Compensation
From falls from high warehouse ladders to slips in the copy room to violent altercations with angry customers, there are hundreds of ways that employees can be injured while at work. When this happens, the injured employee may be entitled to Workers’ Compensation, a type of insurance that provides wage replacement and medical benefits to employees who are injured while on the job. Since a work-related injury can lead to lost wages, expensive medical bills, and other financial strains, Workers’ Compensation can be incredibly beneficial to injured employees.
However, there are a few factors that must be considered before an injured employee can qualify for Workers’ Compensation. In this blog, we’ll walk you through five factors that help determine a Workers’ Compensation claim.
Factor 1: Did the Injury Occur in the Scope of Employment?
According to Florida’s Workers’ Compensation laws, an injury is only compensable for benefits if it is an “accidental injury” or death that arose from “work performed in the course and scope of employment.” This simply means that the injury had to occur while the employee was at work and while they were performing a job-related duty. For example, if someone falls from a ladder while stocking supplies in a grocery store, any injuries would likely qualify for Workers’ Compensation, since the employee was working at the time of the incident. On the other hand, if an employee was hit by a car while chatting with a coworker in the parking lot after clocking out for the day, it would likely not qualify for Workers’ Compensation. This is because the accident did not occur in the scope or course of employment, even though it did technically happen at the employee’s workplace. Similarly, if an accident occurred because an employee was goofing around and improperly using workplace equipment, it might also not qualify for Workers’ Compensation, since they were not performing a job-related duty at the time of the injury.
Factor 2: Is There a Physical Injury?
For an injury to qualify for Workers’ Compensation benefits, it must be a physical injury. Some common examples of physical injuries sustained in workplace accidents include:
- Strains and sprains
- Repetitive injuries, like carpal tunnel syndrome
- Back injuries
- Head injuries and traumatic brain injuries (TBIs)
Less obvious conditions, like a breathing problem that develops from chemical exposure, will likely also qualify for Workers’ Compensation.
Mental injuries, on the other hand, are less likely to qualify someone for Workers’ Compensation. For example, if someone develops severe anxiety after a violent incident with a coworker, they might not qualify for benefits, even if the incident leads to suffering, medical bills, or lost wages. However, if a mental injury is paired with a physical injury—the violent incident leads to a head injury along with anxiety, for example—then a mental injury might contribute to someone receiving benefits.
Factor 3: Was the Injury Influenced or Worsened by Other Conditions?
Even when a physical injury does occur in the scope of employment, the injured employee might have to show that other conditions did not contribute to the injury. For example, if someone is a secretary at work but also writes novels in their spare time, their hobby could be partially to blame if they develop carpal tunnel syndrome.
Similarly, if someone has a pre-existing condition that worsens their injury, it will also be taken into account when considering an employee’s eligibility for Workers’ Compensation. If someone already has a back injury that is exacerbated by lifting a heavy box at work, their employer could deny Workers’ Compensation benefits by saying that the injury already existed. However, if an employee can prove that an incident at work worsened their pre-existing condition, they may still qualify.
Factor 4: Did the Injured Worker Report the Injury?
Obviously, an employer cannot give benefits if they do not know that an injury occurred. This is why it is important for an injured employee to report their injury right away. If they wait to report an injury, their employee has a better chance at arguing that it did not occur in the scope of employment. Even though some injuries may take time to cause pain, it is still critical to report an injury as soon as possible.
Factor 5: Was the Injury Caused by an Employer’s Negligence?
In Florida, Workers’ Compensation is considered to be an “exclusive remedy.” This means that if an injured worker receives Workers’ Compensation, they cannot sue their employer for causing their injury and that any questions about fault and negligence will become irrelevant. Essentially, in exchange for benefits that will help with lost wages or medical bills, employees relinquish their right to sue their employer.
If an injury was caused by gross negligence, like a boss’s blatant disregard of safety protocol or if an employee was forced to work under knowingly dangerous conditions, the employee might want to look into other legal actions before taking Workers’ Compensation benefits.
While these are five of the biggest factors to consider after a workplace injury, finding Workers’ Compensation benefits can be much more complex than simply proving you have a physical injury, especially if your employer fights back against your claims. If you have been injured at work, schedule a case consultation with an experienced Workers’ Compensation attorney.