Am I entitled to benefits?
To be eligible for benefits under the Act, the injured worker must have been an employee of an employer that carries workers’ compensation insurance coverage at the time the work-related injury occurred. The injured worker has the burden of proof to establish that he or she was an employee of the employer for purposes of the Act at the time the injury occurred.
What is my Date of Injury?
The date of injury for a specific injury is the date the injured worker sustained the injury. The DOI for an occupational disease, which includes a repetitive trauma injury, is the date the injured worker knew or should have known the disease may be related to the injured worker’s employment. This is not necessarily the date on which symptoms first appeared, but is the date on which a reasonable person recognizes the nature, seriousness, and work-relatedness of the disease.
Do I have a Compensable injury?
Compensable injury means an injury that arises out of and in the course and scope of employment for which compensation is payable under the Workers’ Compensation Act. Injury means damage or harm to the physical structure of the body and a disease or infection naturally resulting from the damage or harm. The term includes an occupational disease.
Aggravation. An injury includes the aggravation of a preexisting condition or injury. To prove an aggravation of a preexisting condition there must be some enhancement, acceleration, or worsening of the underlying condition from the injury. Pain. Mere pain is not compensable. However, pain accompanied by swelling and medical evidence of aggravation would support a finding of injury.
\What is Extent of my Injury ?
An injured worker who has sustained a compensable injury is not limited to compensation of merely the compensable injury itself if the injury, or any proper or necessary treatment of the injury, causes other injuries in addition to the original compensable injury. The question to be resolved in an extent of injury issue is whether the claimed condition is causally related to or is a part of the compensable injury.
Caused by Medical Care for the Compensable Injury. Medical care causing further injury must be instituted to cure or relieve the injured worker from the effects of his or her injury. Naturally Resulting From the Compensable Injury. Injury is defined as damage or harm to the physical structure of the body and a disease or infection naturally resulting from the damage or harm.
Intoxication is defined as the state of not having the normal use of mental or physical faculties resulting from the voluntary introduction into the body of an alcoholic beverage.
An insurance carrier is not liable for compensation if the injury "occurred while the injured worker was in a state of intoxication. Intoxicated From the Consumption of Alcohol: As a Matter of Law, an injured worker who tests at or above the legal limit for alcohol concentration at the time of the claimed injury is intoxicated for purposes of the 1989 Act as a matter of law.
Intoxication is defined as not having the normal use of mental or physical faculties resulting from the voluntary introduction into the body of a controlled substance or controlled substance.
Drug intoxication does not include intoxication from drugs taken in accordance and as prescribed for the IW by the IW's doctor, and drug intoxication does not include inhalation or absorption of drugs incidental to the IW's work.
Act Of God. An insurance carrier is not liable for compensation if the injury arose out of an act of God, unless the employment exposes the injured worker to a "greater risk of injury from an act of God than ordinarily applies to the general public. Insect Bite. Insect bites and stings have been held not to be acts of God and have been held to be compensable when causation is established.
What if I was fooling around at the time of the injury?
Section 406.032(2) provides that an insurance carrier is not liable for compensation if the injured worker's horseplay was a producing cause of the injury., horseplay involves "rough and boisterous play," "pranks," "fooling," or "friendly attacks," which take the injured worker out of the course and scope of employment.
What if I was injured in a fight at work?
An injury is not compensable if it was caused by the injured worker's willful intention to unlawfully injure another person. An injury caused by the injured worker' s willful intention and attempt to injure another person is not in the course of employment, unless the injury results from a dispute arising out of the injured worker's work or in the manner of performing it and the injured worker's acts growing out of such dispute are done in a reasonable attempt to prevent interference with the work or in reasonable self-defense.
An injury is not compensable if it was caused by an act of a third person intended to injure the injured worker because of a personal reason and not directed at the injured worker in his or her capacity as an employee or because of the employment.
What if I was injured at the company picnic?
Generally, an injury is not compensable if it arose out of voluntary participation in an off-duty recreational, social, or athletic activity that did not constitute part of the injured worker's work-related duties.
What if my injury occurred over time?
A repetitive trauma injury, as opposed to a specific injury, occurs when there is repeated exposure to harmful activities in the work place. In order to recover for an occupational disease of this type, an injured worker must prove that repetitious, physically traumatic activities occurred while on the job.
What is my Date of Injury?
The date of injury for an occupational disease is the date on which the employee knew or should have known the disease may be related to the employment.
What if I have a Heart Attack?
A heart attack is a compensable injury only if the following requirements are proven:
(1) the attack can be identified as: (A) occurring at a definite time and place; and (B) caused by a specific event occurring in the course and scope of theinjured worker’s employment.
What are my responsibilities when I get hurt?
An injured worker, or a person acting on the injured worker's behalf, must report a work related injury to the employer within 30 days after the date of injury.
Generally, an injured worker has one year to file a claim for compensation with the Division unless good cause exists or the employer or insurance carrier does not contest the claim.