A “compensable injury” is a work-related injury that qualifies an employee for workers’ compensation benefits. What counts as a compensable injury is not always clear. Therefore, if you’re a business owner, you should consult with your insurance provider, state workers’ compensation board, and/or legal counsel regarding individual workers’ compensation claims. In the meantime, here’s an overview of what workers’ comp helps cover followed by a quick look at compensable versus non-compensable injuries.

What does workers’ comp cover?

 

Workers’ comp helps cover medical, rehabilitation, and disability expenses for workers who are injured due to their job. Workers’ compensation may also provide death benefits to an employee’s dependents if the worker is killed in a work-related incident. 

 

In addition to helping employees and their families, workers’ compensation insurance also helps cover business owners. Workers’ compensation helps protect businesses from liability for employees’ workplace injuries, and it can help keep employers from having to pay directly out of pocket for those injuries.

 

What constitutes a compensable injury?

 

Depending on the laws in your state, to be considered compensable and therefore eligible for workers’ compensation, injuries must:

 

  1. Have happened to an employee, not a vendor or independent contractor
  2. Be the result of a workplace injury or illness during the course of employment 
  3. Result in impairment and/or lost wages

 

If the injury does not meet these requirements or is not otherwise covered under your state’s workers’ comp laws, it is considered non-compensable and the employee will not qualify for workers’ comp benefits. 

 

What types of injuries are covered by workers’ compensation?

 

Work-related injuries that may be covered by workers’ comp (depending on your state) include:

 

  • Repetitive stress injuries 
    • e.g. carpal tunnel syndrome, tendonitis, bursitis
  • Occupational illnesses
    • e.g. asbestosis, silicosis, sunstroke, hearing loss
  • Mental stress injuries
    • e.g. anxiety, emotional distress 
  • Fatality 
    • e.g. fall from scaffolding, chemical exposure

 

What is not covered under workers’ compensation?

 

What is not covered under workers’ compensation also varies by state, but there are general boundaries. Typically, injured employees will not be covered if they were:

 

  • Under the influence of drugs or alcohol
  • Engaging in horseplay or fighting
  • Commuting to or from work in a private vehicle and not engaged in work activity
  • Participating in a voluntary, unsponsored social gathering with coworkers 
  • Taking a work break off-site

 

Remember, every situation is different and state workers’ compensation laws vary considerably, so do your research as an employer and speak with a trusted advisor.

 

Thanks for reading! Please note that this content is intended for educational purposes only. As laws change regularly, you should refer to your state legislation and/or an advisor for specific legal counsel. If you’re a small business owner, learn more about workers’ compensation insurance or check your current rate in 3 minutes.

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