Legal Guide

What Qualifies as a Workers Comp Claim?

What should you do if you have been injured at your workplace?

First of all, if you’ve been hurt while you are in the workplace, you should let your employer or superior know right away. If you have an injury at work, you have 30 days from the date of the incident to file a report. 

Get a copy of the “Report of Work Injury or Illness” form (Form 801) from your employer. Within 5 days of being notified of your working accident, your employer must supply you with this. Please return the “employee” component of this form to your employer as soon as possible so that they may complete the “employer” section and then submit the form. If you’d like to phone the Oregon Ombudsman’s office, they’ll be happy to send you a copy of Form 801.

Does the injury have to occur on the job for a workers’ compensation claim to be filed?

There is a difference between personal injury and workers’ compensation arising out of a workplace injury. An injury sustained in the course of employment that leads to disability and/or medical care is considered as a workplace injury eligible for workplace compensation. In order to have a successful workers compensation claim, conditions based on the time, place and circumstances of the injury should be met. If either of these conditions is not met, then the employee will not qualify for workers’ compensation. The details of each individual workplace injury are what ultimately matter. 

Injuries such as these may qualify for compensation:

  • In the event that an employee has an injury while commuting in a vehicle provided by their employer.
  • In the event that an employee was sent on a “special errand,” away from the office, to complete a task.
  • Injuries sustained in a parking lot that is under the employer’s supervision are covered by workers’ compensation under the “parking lot rule.”
  • Injuries sustained while on business trips are still working within the course and extent of their employment.

What kinds of illnesses and injuries do employers have to pay for under workers’ compensation?

Typically, when people think of injuries covered by workers’ compensation, they picture catastrophic wounds sustained in a workplace accident. There is more than just accidental injury covered by workers’ compensation. A workplace injury can also be a result of cumulative damage that can also lead to injuries like tendonitis or carpal tunnel syndrome, which develop over time. Workers’ compensation also protects employees from long-term health issues like occupational asthma and contact dermatitis that may be traced back to their jobs.

Is workers’ compensation applicable for all workplace injuries, or do some workplace injuries not qualify?

From a medical perspective, a work-related injury or illness that was not brought on by their job duties in any significant way. If a person has had asthma their whole life and starts experiencing symptoms at work, that is not an occupational disease because the asthma was not “in major part” caused by the person’s work. There are various scenarios in which an injury or illness might not be compensable under the law. Some of these scenarios include:

  • Horseplay: Even if the horseplay is taking place on the job, the employee is no longer acting within the “course and scope of employment” if he or she is actively participating in or instigating it. The only exception is if the employer was aware of the teasing or should have been aware of it and nonetheless allowed it to continue.
  • Hostile or violent employee behavior: Injuries received by an employee who provoked a violent altercation by aggressive behavior or words. If you start the fight with words instead of fists, you’re no longer acting within the “course and scope of employment.”
  • Lunch break: Injuries that occur during lunch breaks are typically not covered by workers’ compensation, though each situation is evaluated separately. It’s important to take into account any exceptional circumstances, such as if the employee was performing a unique task, serving double duty, or socializing on the clock for the company’s benefit.
  • Employee’s use of illegal drugs: If an employer suspects or knows that an employee’s injuries were exacerbated by the use of drugs or alcohol, the burden of proving its evidence is on the employer. The employer also must have not condoned, in any way promoted, or been aware of the employee’s usage.

If you need any assistance with filing workers compensation claims or if you have any questions about Oregon workers’ compensation claim’s process and benefits, you can contact a workers comp attorney.

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