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What Types of Injuries or Illnesses Are Covered by Workers’ Compensation?
What types of injuries or illnesses are covered by workers’ compensation? In Illinois, workers’ compensation law provides coverage for illnesses and injuries that are related to work. An illness or injury is considered work-related if it was caused or worsened by an event or exposure in the work environment, or if it aggravated a pre-existing condition. This encompasses injuries sustained while performing job-related tasks, occupational diseases, and mental conditions developed or worsened due to work-related factors.
What Is Workers’ Comp?
Workers’ compensation insurance provides financial protection for employees injured on the job. Benefits offered to injured workers cover their medical expenses and lost wages during recovery. Workers’ compensation benefits are determined by the severity of the injury, the cost of your medical treatment, and wages you have lost because of the injury or disease. Workers’ comp prevents you from suing your employer in most circumstances. However, there may be situations where you can file a third-party claim against someone else who caused your injuries.
Are Occupational Diseases Covered by Workers’ Compensation Benefits?
If you develop an occupational disease or ailment due to continuous employment, you may be eligible for compensation under workers’ comp. This includes disabilities, impairments, disfigurements, or loss of life due to occupational hazards or diseases arising from your employment, such as exposure to chemicals, dust, fumes, mold, or radiation.
How Occupational Diseases Differ From Regular Workers’ Comp Claims
When you sustain an injury at work covered by regular Workers’ Compensation laws, it is often easier to provide evidence. Usually, a documented incident involving an accident can be verified by your employer’s human resources department, emergency room doctors, your personal physician, and others.
However, the process can be different when filing for an occupational disease. In this case, you may need to demonstrate a condition that developed gradually over time. You must prove that you have been exposed to a disease through your employment that you would not have been exposed to otherwise. Additionally, you need to show that this exposure has resulted in a disability or an inability to work.
What Is an Occupational Disease?
The Illinois Occupational Diseases Act provides direction in workers’ comp claims for occupational disease. While not listing specific types of diseases, it states that employees who suffer disability, impairment, or death due to a disease caused by work conditions are eligible for benefits. If the job worsens a condition, it may qualify for benefits, but the aggravation must result from a work-specific risk, not a risk faced by the public. For example, air quality in the workplace exacerbating asthma could be considered for workers’ comp.
Common Occupational Diseases
Common diseases caused by work-related conditions include
Allergic and Irritant Dermatitis
This condition accounts for 15% to 20% of all workplace disease reports. Due to the possible causes, employees in various occupations may be at risk. The annual expenses for treating work-related skin conditions are nearing $1 billion. Prolonged exposure to irritants can result in persistent skin issues.
Asthma and Chronic Obstructive Pulmonary Disease (COPD)
Around 30% of individuals with asthma and COPD reportedly developed their conditions due to exposure in the workplace. According to the Centers for Disease Control, over 20 million workers in the United States have encountered substances that can lead to respiratory diseases.
Fertility and Pregnancy Abnormalities
The primary reason for infant mortality is birth defects, some of which can be attributed to exposure to hazardous chemicals in the workplace. The CDC believes that there hasn’t been sufficient research conducted on fertility problems related to workplace exposure to harmful conditions. Nonetheless, the CDC acknowledges that 1,000 industrial chemicals have been found to impact fertility in animal studies.
Hearing Loss
Employers must offer protective measures in various situations, as this condition can result from a single acute incident or prolonged exposure to loud environments.
Infectious Diseases
The main impact of these illnesses is on healthcare professionals. The most prevalent diseases include hepatitis B and C, HIV, and tuberculosis. Other professionals with a high risk of exposure are social workers, correctional officers, and laboratory workers.
Can Mental Health Conditions Be Covered?
Workers’ comp’s general principle is to compensate employees for lost income and medical expenses resulting from work-related injuries or illnesses. Unlike physical injuries, mental health conditions like depression, anxiety, and PTSD can be more challenging to measure objectively, making it difficult to prove their work-related nature.
Due to this, some states do not include psychological injuries in workers’ comp coverage. Illinois does cover mental health conditions, but the law sets restrictions on when benefits can be claimed.
Illinois Workers’ Comp Laws on Psychological Injuries
Illinois workers can receive workers’ comp benefits for psychological injuries in certain situations. The state’s law recognizes three types of workplace psychological injuries.
- Physical injury can lead to psychological harm.
- Psychological stress can result in physical injury.
- Psychological trauma can cause psychological harm.
The success of your workers’ comp claim depends heavily on the type of psychological injury you’ve sustained and the facts of your case. Mental/mental injuries are the hardest to prove, followed by mental/physical, and finally physical/mental.
Regardless of which category your case falls into, you’re more likely to recover workers’ comp benefits for a mental health condition in Illinois if a mental health professional has diagnosed you with the condition, as not all workplace stress rises to the level of a psychological injury or mental health disorder. Additionally, you must be able to prove that your mental health issues were caused by your work, rather than arising from a preexisting psychological condition or personal problems such as financial troubles or family conflict.
Physical Injury Leading to Psychological Harm
Illinois workers’ compensation law allows you to receive benefits if you experience a psychological injury from a work-related physical injury. You are eligible for benefits regardless of whether your mental health condition occurred during or after the physical injury.
For example, if you fall off a ladder at work and suffer serious back injuries, leading to severe depression, or if you are involved in a work-related car accident and experience both physical injuries and PTSD, you can seek benefits.
Proving a physical/mental claim is generally no more difficult than proving a claim for a purely physical injury. You don’t need to demonstrate that your physical injury was the sole cause of your psychological injury; you just need to show that it was a contributing factor.
Furthermore, the physical injury that causes your mental health condition doesn’t have to be particularly severe or result in objective evidence of harm—it’s sufficient that you’ve experienced even minor physical contact.
Psychological Stress Resulting in Physical Injury
When you experience work-related psychological stress that leads to a physical injury, you are eligible for workers’ comp benefits. For instance, work-induced stress that causes a heart attack or ulcers would qualify as this type of injury.
Proving this mental/physical claim is more challenging than demonstrating a physical/mental claim. To succeed, you have to demonstrate that:
- Your work stress exceeded the typical stress levels experienced by the public.
- It is more likely than not that your work stress contributed to causing your physical injury.
Even if you have a preexisting condition like cardiovascular disease, you might still be able to recover if you can demonstrate that your excessive work-related stress contributed to your physical injury. Providing medical testimony from a doctor can be especially helpful in establishing this causal link.
Workers’ Comp Benefits for Purely Mental or Psychological Injuries
In Illinois, you’re entitled to benefits for purely psychological injuries with no physical component if they result from work-related psychological stimuli, such as mental health conditions from extraordinary situations like workplace shootings or witnessing severe physical harm to another employee.
Proving workers’ comp claims for purely psychological injuries is more challenging. To succeed, you typically need to demonstrate that your psychological injury was caused by a sudden, severe emotional shock traceable to an extraordinary event and that this work-related traumatic event was the primary cause of your psychological injury.
Even if you work in a profession where highly stressful or traumatic events are normal, such as police officers or firefighters, you can still recover workers’ comp benefits if you prove that your mental health condition was caused by work-related severe emotional shock.
In general, you can’t recover workers’ comp benefits in Illinois for mental health conditions that develop over time due to normal, day-to-day work stress. However, you may be able to recover benefits if your mental health condition was caused by a series of abnormal work stressors, such as repeated verbal abuse, threats of violence, and witnessing violence against others.
To prevail on a claim based on a series of abnormal work stressors, you need to show that the work stressors were the primary cause of your mental health condition.
What Injuries Are Excluded From Workers’ Compensation Benefits?
Not all injuries are covered under workers’ comp. Excluded injuries include:
- Injuries outside work hours are not covered by workers’ compensation, including those during personal errands or weekend activities.
- Injuries resulting from horseplay or non-work-related activities are typically not covered, including injuries sustained from pranks, fights, or other non-professional behavior.
- If an employee is intoxicated and the intoxication was the primary reason for an accidental injury, they may not be entitled to compensation. This includes cases where an employee’s blood alcohol level was above .08% or if illegal drugs were in their system.
- Failure to notify the employer about an injury promptly may forfeit the employee’s right to workers’ compensation benefits.
- Injuries or illnesses with unknown causes that cannot be directly or indirectly linked to the employee’s job may not be covered.
Other cases where an injured employee may not be eligible to claim workers’ compensation include when the employee engaged in illegal activities while at work, behaved recklessly, violated company workplace safety regulations, caused self-inflicted injuries, or demonstrated willful misconduct. Willful misconduct could involve reckless behavior, misconduct, failure to follow occupational safety and health rules, or injury due to carelessness.
When making a workers’ comp claim, a personal injury lawyer can be invaluable in preparing the claim to ensure that after a workers’ comp investigation, your claim is accepted and you receive maximum compensation. Contact us at Strong Law in Bloomington for a lawyer to assist you with preparing and filling your workers’ comp claim.
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