Do I Qualify - Related Questions

Which injuries are covered?

The most common type of injury in Workers' Compensation claims is a "soft tissue" injury. What this means is that the injury sustained has affected muscles, ligaments, tendons, or nerves. Common soft tissue injuries include:

  • Neck sprains or strains
  • Torn rotator cuff and shoulder injuries
  • Knee injuries including torn cartilage or ligaments
  • Cervical, Eye, or Bursitis pain (tendon damage)
  • Carpal Tunnel Syndrome (ligament damage) and wrist and elbow injuries
  • Sciatica and other damaged nerve injuries
  • Low back pain or herniated lumbar disc
  • Concussions or post concussion syndrome
  • Repetitive motion injuries

Other common Workers' Compensation injuries include:

  • Fractured or broken bones and joints including broken arm, broken leg, and fractured hip
  • Hearing or vision loss
  • Ulcers and stress related illnesses such as high blood pressure and cardiovascular disease
  • Psychological injuries including post-traumatic stress disorder (PTSD), depression, and anxiety

Typically an injury covered by Workers' Compensation must be a physical injury. Often, treatments for psychological trauma or injuries will be covered if the condition is diagnosed as resulting from the initial physical injury. However, this policy varies from state to state. An injury that is only psychological and is not physical in nature is not covered in many states. Nonetheless, states will consider a claim of psychological injury based on the following federal regulations for a psychological claim:

  • Establish that an event, situation, or allegation occurred to precipitate the psychological condition
  • That this event occurred while performing official duties or an activity appropriately related to the employment
  • There has been a medical diagnosis of the psychological condition
  • That the medical diagnosis establishes a connection between the event, situation or allegation to the psychological condition
  • Finally, the claim must be filed within the same regulations governing physical injury claims

How long must I out of the work?

While the figure varies from state to state, typically, if you are unable to work for more than seven days you will be eligible for a Workers' Compensation claim. The claim will cover the period of time you were unable to work. Generally, if you have been unable to work for a period of time longer than 21 days, the claims process becomes more complex. It is important to note that the days you are unable to work do not need to be consecutive. Thus, if you miss 3 days of work one week and 5 days of work another week due to the same injury you may be eligible for Workers' Compensation. If you have a work-related injury that has limited the number of days you are able to perform your job, keep a record of days missed as a result of this injury. When filing your Workers' Compensation claim it will be important to document the days you missed as a result of your injury. Furthermore, be sure to alert your employer when you are unable to work as a result of this injury.

What if I'm a federal employee?

A federal employee is a worker that is paid by the federal government. This includes Postal Workers, Homeland Security Agents, Customs Agents, and other related government agencies. The federal government operates and manages its own Workers' Cmpensation program. This program has specific guidelines and regulations that differ from the myriad of different state programs. The Federal Employees' Compensation Act (FECA) is managed by the Office of Workers' Compensation Programs (OWCP). The OWCP provides four major disability compensation programs, which offer wage replacement benefits, medical treatment, vocational rehabilitation and other benefits to certain workers or their dependents who experience work-related injury or occupational disease.

Federal civilian employees of the United States are eligible for compensation benefits for disability due to personal injury sustained while in the performance of duty or to an employment-related disease. FECA also provides for the payment of benefits to dependents if the injury or disease causes the employee's death. Similar to most state statutes, benefits cannot be paid if the injury or death is caused by the willful misconduct of the employee or by the employee's intention to bring about his or her injury or death or that of another, or if intoxication (by alcohol or drugs) is the proximate cause of the injury or death.

A federal employee is entitled to medical, surgical and hospital services and supplies needed for treatment of an injury as well as transportation for obtaining care. The injured employee has the initial choice of physician and may select any qualified local physician or hospital to provide necessary treatment, or may use agency medical facilities if available. Except for referral by the attending physician, any change in treating physician after the initial choice must be authorized by OWCP. Otherwise, OWCP will not be liable for the expenses of treatment.