What Types of Injuries are Covered?
Pre-Existing Conditions and Injuries A common but mistaken belief is that a medical condition or injury that predates the start of employment is not compensable. An employee is not barred from receiving benefits simply because he or she has a pre-existing injury, disability or medical problem. However, the new work-related injury must be a major, but not necessarily predominant, cause of the disability or need for treatment.
The Massachusetts Workers' Compensation Act requires an employer to accept an employee "as is." If an incident at work aggravates an pre-existing condition in a major way so that the employee cannot work, the entire disability is work-related and the insurer must pay benefits.
Occupational Diseases Workers in the manufacturing and construction industries are sometimes exposed to toxic substances. Diseases resulting form such exposures are covered. Infectious or contagious diseases are also compensable if the risk of infection is "inherent in the employment." For example, the risk of contracting tuberculosis or hepatitis is inherent in healthcare employment.
Heart Attack Heart disease, or coronary artery disease, may be caused by a variety of factors such as stress, diet, hereditary predisposition and smoking. As already noted, benefits are not lost merely because an employee has a pre-existing condition.
Heart attacks can be brought on or "precipitated" by physical or mental exertion in the workplace. Where that is the case, an employee may be eligible for benefits even though he or she has a pre-existing heart condition.
Heart Attacks Away from Work A heart attack need not take place at work to be compensable. If chest pain and/or other symptoms (such as nausea and sweating) started at work and were fairly regular until the time of the attack, the injury may be covered. The particular facts of each case, especially as reported at the time to co-workers, supervisors, and doctors, will determine the success of a claim.
Chronic Trauma Recovery of compensation benefits does not always depend on an employee's ability to recall a specific incident that led to an injury. Some conditions - such as hernias and back problems - are the result of repetitious job functions that put stress on certain parts of the body. The general term for the cause of such injuries is chronic trauma.
There are subtle differences between injuries due to chronic trauma and damage caused by the "normal wear and tear" of the job. Compensation will not be awarded for normal wear and tear.
Some factors that distinguish chronic trauma from wear and tear are:
Many back ailments, problems with knees and nerve damage are examples of the results of chronic trauma.
Mental or Emotional Illness Disabling episodes of depression, anxiety and other mental or emotional problems are compensable if a specific, stressful work incident (or series of events) is the predominant contributing cause of the illness. However, like other types of injury already discussed, mental or emotional disabilities are subject to the "normal wear and tear" rule. The fact that a job is stressful will not, by itself, be enough to recover benefits for a nervous breakdown. There must be precipitating physical or mental trauma at work. This is an exception to the "as is" rule noted earlier. If an employee has a history of mental or emotional problems pre-dating employment and the employee's particular sensitivity makes him or her unsuited to the job, recovery of benefits is unlikely.
Mental or emotional injuries occurring after January 1, 1986, as a result of a bona fide (good faith) personnel decision - such as a transfer, demotion, or discharge - are not compensable. An exception to this rule is the case where the personnel decision amounts to intentional infliction of emotional harm.
Injuries on the Employer's Premises An employee does not have to be actually performing his or her job duties when injured in order to receive workers' compensation. What is required is that the employee be on the premises. A slip and fall in the employer's cafeteria during lunch or in the plant parking lot on the way into or home from work may be a compensable injury.
Travel Injuries The general rule is that accidents occurring while off the premises, but during travel to and from work, are not compensable. An exception is made for special trips required by the employer. This includes injuries that happen on business trips, travel between worksites, customer service calls, and the pick-up and delivery of supplies or goods.
Other Injuries It would be impossible to list here all the types of injuries and related circumstances that are compensable. If you have an illness or condition that may be work related, and have been out of work for five work days, consult an attorney.
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