Worker's Compensation Guidebook for Employees

DEFINITION OF “INJURY"

A. Accidental Injuries

The most common situation covered by the Act occurs when an employee has an accident at work which results in an injury. Examples of these types of injuries include a slip and fall on a wet floor or an accidental cut with a knife while chopping food. In these instances, benefits are payable regardless of whether the employer or employee was at fault in causing the accident. It doesn’t matter if you or the employer was negligent in some way – you still are entitled to receive medical and wage loss benefits.

There are a limited number of exceptions to this rule. For example, the injury claim will not be accepted if the employee’s injury is intentionally self-inflicted, is caused by an employee’s intoxication and/or use of illegal drugs or is caused by the employee’s violation of a positive order. There is also an exception if the employee’s injury is caused by a third party for personal reasons. In this case the employee may have a private lawsuit against the person who harmed him, but the employer has a defense to the workers’ compensation case.

B. Aggravations of Previous Medical Conditions

1. Aggravation of prior work-related injuries – A worker may re-injure a part of his body which he previously injured at work. In this case, there is a question whether the new disability is related to the old injury or whether it should be considered a new injury. This can be significant if there was a change in insurance companies between the old and new injuries, or if the employee was earning higher wages at the time of the new injury.

In general if you suffer a new accident or incident which directly impacts the area of an old injury, the doctor will decide that you have had an “aggravation”, which is considered a new injury. There will be a new calculation of the amount of weekly wage benefits based on the wages you were earning at the time of the new injury. This is contrasted with a situation where an employee has an injury which worsens over time and eventually causes disability. This is likely to be considered a “recurrence” of the old injury. In this situation, benefits would be reinstated at the rate paid at the time of the original injury.

2. Aggravation of a non-work medical condition – Employees are sometimes surprised to learn that they are entitled to workers’ compensation benefits if they have a medical condition unrelated to work which is aggravated by a work injury. In these cases, it is critical to have a doctor’s opinion that the work incident was a “substantial contributing factor” to the person’s disability. If this opinion is obtained, then the worker is entitled to worker’s compensation benefits for the period of disability.

C. Other Types of Injuries

1. Occupational diseases – Under the workers’ compensation law, any disease that is caused by employment or is aggravated by occupational exposure is compensable. These diseases include bronchitis, asthma and hepatitis as well as others. There are some specifically stated diseases in the Act, such as cancer caused by asbestos exposure or black lung disease, for which it is presumed that the disease arose in the course of employment. For all other diseases, the employee must prove the causal connection by a doctor’s testimony.

2. Hearing loss – As of February 23, 1995, there is now an objective standard to determine whether an employee has lost enough hearing to receive benefits as a result of exposure to work noise. If a worker suspects that his hearing is compromised due to long term exposure to occupational noise, he should be evaluated by an audiologist. The audiologist will perform testing and give an opinion as to whether the worker’s impairment is sufficient to qualify him for benefits.

3. Specific loss – The specific loss part of the Act applies to workers who have had the amputation or permanent loss of use of any of the following: loss of a member of the body, complete loss of hearing in one or both ears or complete loss of vision in one or both eyes. Specific loss benefits are also payable if an employee has permanent disfigurement of the head, neck or face as a result of a work injury. These benefits are paid as one lump sum based on a calculation derived from the worker’s weekly benefit rate.

4. Death benefits – Death benefits are available to any dependent spouse and minor children of a worker whose death occurs as a result of a work injury. These benefits include payment of weekly wage benefits and burial expenses. The benefits are discontinued if the spouse remarries and the children reach majority age.


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