What Qualifies as a Work-Related Injury? Guide for Injured Workers

If you get sick or hurt at work, then you might automatically assume that health issue qualifies for workers’ compensation benefits. But every state has its own unique workers’ compensation laws, insurance requirements, and reporting rules. As a result, understanding what qualifies as a work-related injury or illness isn’t always clear. Once you understand the logic behind the law’s decisions, though, it becomes a whole lot easier.

Keep reading to better understand when you’re most likely to qualify for workers’ compensation insurance benefits.

Understanding What Qualifies as a Work-Related Injury or Illness: Key Takeaways

• You can file a workers’ compensation claim for any injury or illness you develop while doing your job, provided your employer has coverage. In most states, any employer with one or more employees must have workers’ compensation insurance. But laws vary by state, so be sure to confirm you have coverage through your employer before filing a claim.
• Every state automatically exempts certain types of employees from workers’ comp coverage, such as independent contractors and federal workers. If you don’t have insurance coverage through your employer, then you may file a personal injury lawsuit instead.
• Workers’ comp benefits are part of a no-fault system that mostly covers medical bills and in some cases, lost wages. This means you automatically waive your right to sue once you accept any workers’ compensation benefits from your employer’s insurance company.
• Unless you seek medical treatment for a workplace injury, you’re not eligible for workers’ compensation. Doctor’s bills are the first and most important requirement in order to qualify for workers’ comp benefits.
• Only injuries and illnesses sustained during the course and scope of your employment can qualify for workers’ compensation benefits.
• If you have any pre-existing conditions, work from home, or travel a lot for your job, you likely need a workers’ comp lawyer. You can sign up for a free, no-obligation consultation through this website to better understand your legal options.

How “Course and Scope of Employment” Helps Define Eligible Occupational Injuries and Illnesses

Just getting hurt while you’re at work is not enough to get you workers’ compensation. To qualify for benefits, you must show the injury or illness happened within the course and scope of employment for your job. Only injuries that happen while performing an employee’s work duties and during that employee’s assigned working hours should meet this requirement. If you’re hurt outside of work, then workers’ comp will not pay for those medical expenses.

What “course and scope of employment” does not mean is any of the following:

• You’re hurt in a motor vehicle accident that occurs in your company parking lot, or while driving to or from your job or on a company access road
• You felt ill when you got to work and clock out early because you’re running a fever
• You’re a little bit drunk at an office party and fall down some stairs, breaking your leg
• One of your coworkers or a customer punches you or starts a fight at work
• You choke on a sandwich you brought from home while eating it on your lunch hour
• You have hearing loss after refusing to wear earplugs while working construction sites

Which Occupational Diseases Commonly Qualify As a Work-Related Injury for Receiving Workers’ Compensation Benefits?

Some things that sound like injuries instead count as an occupational illness because they develop slowly over long periods of time. So, what qualifies as a work-related injury if you’re not sure whether it’s an illness or not? Below are some examples that will help you potentially qualify for workers’ comp benefits.

Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome is perhaps the most common reason why people file workers’ compensation claims in the United States. It happens after a long period of repeating the same hand and arm motions over and over again, usually at work. Carpal tunnel falls under a group of long-term issues commonly known as “repetitive stress injuries” or “repetitive motion injuries.”

And as long as you can show your job significantly aggravated a pre-existing injury, it’s okay if you’ve had flare-ups before. If you need carpal tunnel surgery, don’t put it off. Instead of putting yourself at risk permanent nerve damage and muscle atrophy, file a workers’ comp claim with your employer.

Silicosis

People have been developing silicosis from a workplace event or exposure to silica dust since Hippocrates wrote about it in 400 B.C. If your job exposes you to airborne silica particles, then you’re at increased risk for developing silicosis lung disease. When you breathe in these tiny airborne particles, they become trapped inside your lungs. Eventually, these fibers cause lung tissue to harden and scar over, limiting your ability to breathe normally.

There is no treatment for chronic silicosis, which can happen after 10+ years of regular, low-level occupational exposure. A 2024 study found that silicosis killed 16,305 workers between 1968 and 2002. Workers in these industries are most at risk for dying of silicosis:

• Mining or quarrying jobs (silica dust is present in nearly all mining occupations)
• Sand-blasting jobs within energy production (i.e., oil drilling, fracking, or refining) or maritime industry fields (esp. shipyard work, military vehicle maintenance)
• Construction jobs (i.e., masonry work, jack-hammering, tunneling, rock-drilling or sandblasting)
• Foundry jobs or work firing any kind of ceramics, clay, or pottery in a kiln
• Stone-cutting and glass manufacturing jobs
• Agricultural jobs
• Manufacturing jobs involving abrasives, soaps, or detergents
• Railroad jobs (i.e., setting and laying down tracks)

Mesothelioma

Occupational exposure to asbestos fibers caused 91.7% of mesothelioma deaths in 2019. means 24,312 people died after breathing in asbestos fibers in the workplace that year. Perhaps more importantly, asbestos is the only thing on earth known to cause mesothelioma.

Mesothelioma is a rare but usually fatal lung cancer that qualifies as a work-related injury for workers’ compensation benefits. Globally, 69 countries now ban use of asbestos fibers, but to date, the United States has not. Unfortunately, America ranks first for mesothelioma deaths. Workers most at risk for developing it from workplace exposure include:

• Miners
• Construction workers
• Factory workers
• Military veterans (account for 1 in 3 diagnoses each year)
• Firefighters
• Textile mill workers
• Auto repair mechanics

Workers’ Compensation Exceptions Every Employee Should Know

Below are examples of some exceptions for injuries that do not qualify for workers’ compensation benefits in any U.S. state.

Injuries Sustained While Doing Personal Tasks at Work or Consuming Food Prepared for Your Own Personal Consumption

If you eat leftovers you brought from home in the work cafeteria and choke, it’s exempt under Occupational Safety and Health Administration (OSHA) rule 1904.5(b)(2). This rule states under subsection (IV) that:

“The injury or illness is solely the result of an employee eating, drinking, or preparing food or drink for personal consumption (whether bought on the employer’s premises or brought in). For example, if the employee is injured by choking on a sandwich while in the employer’s establishment, the case would not be considered work-related.”

And subsection (V) of that same OSHA rule says any injury sustained while doing personal grooming or other tasks outside of the employee’s job-related duties are also automatically exempt. So if you burn yourself on a straightening iron between clocking out and your dinner date, then workers’ comp won’t cover that.

Voluntary Participation in a Workplace Event

Let’s imagine that you sign up to donate blood or take a fitness class that happens in your office during normal work hours. What happens if you pass out during one of these events and knock out a tooth? Unfortunately, that’s also an example of an exempt injury that will not qualify for workers’ compensation benefits under OSHA rule 1904.5(b)(2), section (iii). It states “The injury or illness results solely from voluntary participation in a wellness program or in a medical, fitness, or recreational activity such as blood donation, physical examination, flu shot, exercise class, racquetball, or baseball.”

Visits to Your Employer’s Establishment While Not Clocked In

An injury that happens while you’re on your employer’s premises does not necessarily make it a work-related injury. You can visit your workplace outside of normal work hours to collect a Christmas bonus, for example. Or maybe you forgot something in your locker Friday evening and drop by to pick it up Sunday afternoon. If you slip on a wet floor during that visit, then it won’t count as a work-related injury.

Other Exceptions That May Apply in Your Case

Intentionally self-inflicted wounds or injuries that arise as a result of intoxication on the job generally cannot qualify for workers’ compensation. That remains true even if you’re attending a work-related event that encourages drinking (a company happy hour, for example).

In addition, OSHA rules specifically exempt car accidents in a company parking lot, on an access road, or during your work commute. You also cannot qualify for workers’ compensation benefits if your injury results from refusing to use required safety equipment provided by your employer.

Last but not least, it’s extremely hard to get workers’ comp payments for any mental health issue. OSHA rules exempt mental illnesses from workers’ compensation unless you submit an opinion from a licensed health care professional affirming that your issue is work-related.

What Qualifies as a Work-Related Injury When You’re Working From Home (WFH) or in a Remote Location?

Not only physical locations that your employer owns and operates count as your workplace for filing a workers’ compensation claim. Since 2020, working at home is much more common, as is remote working in other locations.

Here are some examples of work-related injuries that can happen when you’re WFH or work remotely:

• You develop myopia or eyestrain from completing legal document reviews as required for your law firm employer.
• While soldering a new chip onto a motherboard in the process of repairing it as part of your job duties, you accidentally burn yourself.
• A hotel ceiling falls in and strikes you unconscious during your speaking engagement at an annual work conference.
• You strain your back lifting a large package from your employer containing your new standing desk and work laptop.

What if You Have a Pre-Existing Condition That Gets Worse While Doing Your Job?

The workers’ comp claims process gets a lot more complicated for issues like these. A pre-existing condition is anything that comes from a non-work-related event or source of exposure. There are two things to keep in mind if you aren’t sure whether it’s work-related or not:

1. If your current job tasks significantly aggravated an old injury, then you may qualify for workers’ comp benefits. For example: You stopped doing gymnastics in college due to frequent hand, wrist, and elbow injuries. Then, you develop carpal tunnel syndrome from scooping ice cream at your summer job. It doesn’t matter that you hurt your arm, hand, or wrist many times before your current job role. what matters is that your job scooping ice cream significantly aggravated those old injuries, and now, you can’t do it as effectively.
2. If your job role caused or contributed to the resulting condition, then it may be considered work-related for workers’ compensation purposes. Imagine you’re an EMT with asthma who treats several smoke inhalation victims near an active wildfire. If you’re then hospitalized for pneumonia, is your asthma really to blame — or your job?

What Responsibility Does an Employer Have Towards an Injured Employee?

Every employer has a duty to create a safe work environment for their employees, which includes:

• Giving you any necessary protective equipment required to do your job safely, as expected. This includes things like safety goggles, adequate hearing protection, and appropriate training for any job tasks you perform regularly.
• Posting clear, visible warning signs regarding any potential workplace safety hazards. For example: “Wet Floor” signs near water spills, posters in break rooms with steps to take in case of a workplace accident, etc.
• Conducting regular inspections and audits to identify and fix any potential dangers that put employees in harm’s way. This includes things like asking police to perform extra patrols in the area for overnight shift workers, for example. Or limiting how many planes a UPS worker can unload in one eight-hour work shift during high or low temperatures.
• Purchasing workers’ compensation insurance coverage for all eligible employees according to that state’s laws. This provides injured workers with benefits to cover medical expenses when a work-related accident occurs.

How to Report an Occupational Safety Hazard in Your Work Environment

If you notice something dangerous at work or identify a hazard that puts you or you coworkers in danger, report it immediately. OSHA cannot issue citations to employers for violations that are more than 180 days old, so don’t wait!

To report a workplace safety hazard, you can:

• Call 1-800-321-6742 (OSHA) if you have an immediate issue or emergency situation to report. If you’re hard of hearing or deaf, use TTY 1-877-889-5627 instead.
• Go to your local OSHA office to report your complaint in person.
• Visit OSHA.gov to submit an online complaint form in English or in Spanish.

How to Get a Free Legal Consultation on Your Workers’ Comp Case

Still not sure what qualifies as a work-related injury when it comes to your own situation? A skilled attorney can help protect your rights under your state’s laws if you suspect your employer owes you workers’ compensation benefits. The best part is most workers’ comp lawyers work on contingency. That means you won’t pay legal fees until after you receive a cash settlement.

LegalASAP’s consultations are always free and don’t obligate you to do anything else. Deciding if and how you want to proceed with a potential case is always 100% up to you.

Ready to see if you may qualify? Complete your free online workers’ comp claim evaluation now or call 1-888-927-3080 anytime and we will do everything we can to help you: