Are All Injuries Covered by Workers’ Comp? NO!

No, they aren’t! However, many people think that all on the job injuries are covered and as a result, they fail to report their on-the-job injury accurately when they do get hurt.

For most injuries to be covered, you have to be injured as the result of an “accident.” An accident is defined in North Carolina workers’ compensation law as an event that is unexpected, “untoward or unlooked for” that “interrupts your normal work routine,” causing an injury. Insurance adjusters sometimes refer to an accident as a “slip, trip, or fall” but an accident can be a much more subtle event. Clearly, if you fall off a scaffold and break your arm, you have been injured by accident. But “injury by accident” cases can also include incidents such as an injury that occurs when you are learning brand new job duties that are different from your previous duties. In addition, if you are at work and you fall down and get hurt and you do not know why you fell, that counts as an accident due to the “unexplained fall” rule. If you injure one of the big joints in your body, such as your knee or your shoulder, in one specific incident, then it needs to be an “accident” in order to get it covered. Injuring a body part while going about your normal job routine would not be an injury that is covered by workers’ compensation, due to the lack of an “accident.”

If you injure your back or neck, or develop a hernia, there is another rule that also applies. The “specific traumatic incident” rule applies in addition to the “injury by accident” rule to these body parts. You can have a covered back injury, or a covered hernia or rupture, if you have a “specific traumatic incident of the work assigned.” This means, that if you are assigned to lift heavy boxes and move them from one pallet to another, and you pick up one of those heavy boxes and injure your back or develop a hernia, those injuries should be covered, even though picking up the box was part of your normal job routine and therefore was not an “accident.” So back, neck and hernia injuries are an exception.

There is a third way to get an injury covered known as an “occupational disease.” There are a number of specific diseases listed in the law as being covered if they are a result of your work. However, many occupational diseases that could be covered are not listed. If you develop something other than a listed condition, or develop an injury due to repetitive motion or repetitive trauma, such as carpal tunnel syndrome, then there is a specific and complicated occupational disease legal standard that you must meet in order to get it covered. That standard is set forth in General Statute 97-53(31) and it requires that the job caused the condition, and that the job put you at a greater risk than the general public not so employed, of developing that condition. Many people lose their occupational disease cases because they cannot meet this standard of proof.

As you can see, not all injuries at work are going to be covered by workers’ compensation. For most injuries, you need an injury by accident. For a hernia or an injury to your back or neck, you can get it covered if you have a “specific traumatic incident,” which is a smaller event than an “accident.” And if you have a specific work-related disease, or a repetitive motion condition, we might be able to get it covered as an occupational disease. If your injury does not fall into one of these three categories, it is not going to be covered by workers’ compensation.

Many people lose their injury by accident cases when the insurance company calls them to take a recorded statement, because, in the recorded statement, the injured worker fails to provide all of the details necessary to show that he or she suffered an “injury by accident” as opposed to an injury while going about their normal job routine. If you get hurt at work and have any questions about whether your injury is going to be covered, call us for a free consultation before you talk to the insurance company’s investigator! Get our advice before you blow up your case!