Is Your Injury Work-Related? How to Prove Your Claim

To qualify for workers’ compensation benefits, you must prove you have a work-related injury or illness. But if you already have pre-existing health conditions, this may be harder for you than for others. Occupational Safety and Health Administration (OSHA) guidelines help define what is work-related and what isn’t, so let’s start there.

How OSHA Defines Work-Related Injuries and Illnesses

Fortunately, OSHA’s detailed guidelines explain what does and does not count as “work-related” for those filing workman’s comp claims. Let’s explore some examples that show these key differences in what counts and what doesn’t. First, an employer must find it a work-related injury or illness if a workplace event or exposure during working hours:

• caused or contributed to your injury or illness
• significantly aggravated a pre-existing injury or illness

The government defines work-related events or exposure as “the establishment and other locations where one or more employees are working or are present as a condition of their employment.” Your work environment includes physical locations as well as equipment or materials you must use to complete your own job tasks.

Situations That Don’t Count as Work-Related Injuries or Illnesses

Any workplace injury or illness not covered under workers’ compensation claims usually falls under OSHA’s exception list. We’ve listed helpful examples after each exception listed below.

Exception #1: You were visiting your workplace in a non-employee role when the injury/illness occurred

For example: You work waiting tables at a restaurant and take friends there to eat on your day off. While there, you slip on ice from a spilled drink and dislocate your arm. This injury is not work-related and therefore won’t qualify for workers’ comp benefits.

Exception #2: Your injury/illness symptoms begin while working, but the cause is not related to your job duties or a work-related event

For example: Your child goes home from school early with a fever. You also develop a fever several hours later at work, then test positive for influenza. While you initially felt sick at your job, it’s not a work-related illness.

Exception #3: Your injury/illness happens while voluntarily participating in a wellness program or medical, fitness, or recreational activity held at your workplace

This exception applies to any activities employees often do in the workplace, but not required as part of their job duties. Some example situations may include blood drives, physical exams, flu shots, exercise classes, etc. where all participation is 100% voluntary.

Exception #4: Your injury or illness happens after eating, drinking, or preparing your own personal food/drink in the workplace

For example: If you choke on a snack at work, it’s not a work-related injury. What if you cut your finger while slicing up an apple to eat on your break? That’s not work-related, either. However, there’s one exception to this rule. If workplace contaminants in your food or employer-provided meals make you sick, they’re work-related illnesses.

Exception #5: Your injury or illness results solely from doing personal tasks unrelated to your job or outside your regular working hours

For example: You’re shaving in the work bathroom before your shift and accidentally cut yourself. Or, you’re straightening your hair after you clock out and burn your hand. These are not work-related injuries, even though they occur in the workplace.

What About Injuries or Illnesses That Happen While Working From Home?

Working from home is more common now, which means you could have a workplace injury your own house. Injuries and illnesses that happen while working remotely must meet certain requirements to qualify for workers’ comp. Work-related means any injury or illness that happens while performing your job duties. But if your home environment or setting directly causes your injury/illness, it will not qualify for workers’ comp.

OSHA examples of work-related injuries at home:

• You drop a heavy box of work documents at home and injure your foot. This case counts as work-related when applying for workers’ compensation.
• You’re altering a garment on your home sewing machine and get an infection after the needle punctures your fingernail. Since you own a tailoring business and need medical treatment, this counts as a work-related injury.

OSHA examples of at-home injuries that won’t qualify for workers’ comp benefits:

• You trip over your dog while rushing to answer a work call at home and sprain your ankle. This injury does not qualify for workers’ comp.
• You go to the hospital for smoke inhalation after faulty wiring sparks a fire in your house while working from home. This is not a work-related injury.

You May Qualify for Legal Assistance

Still not sure if you qualify for workers’ compensation? It’s a good idea to speak to a lawyer before filing your workers’ comp claim. Our lawyers offer free consultations and give confidential answers to all your workers’ comp questions. You can sign up for a free, no-obligation phone call and get confidential advice that applies to your specific situation.

Ready to see if you may qualify? Click the button below to start your free online benefits evaluation now.

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