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Workers’ Compensation Benefits for Chronic Conditions

When most people think about workplace injuries, they picture one-time accidents like a slip and fall or getting a hand caught in machinery. But many employees develop injuries or illnesses gradually as a result of work conditions or activities that are a regular part of their job. If this has happened to you, you should generally be eligible for workers’ comp benefits. Still, you could face extra hurdles to prove that your medical condition was caused by your work rather than activities in the rest of your life. And that may be more difficult in some states than in others.

Occupational Diseases

Ongoing exposure to harmful substances at the workplace can cause occupational illness such as:

  • black lung disease (from inhaling coal dust)
  • mesothelioma (a cancer caused by exposure to asbestos)
  • asthma (from inhaling various kinds of dust), and
  • skin diseases (from direct exposure to chemicals).

The definitions of occupational diseases—and the requirements for proving that you have such an illness—are somewhat different from state to state. Typically, you’ll need medical evidence that your on-the-job exposure caused a type of illness that is a particular risk in your line of work—more so than in other jobs or for the general public.

If you have a disease that many people develop outside of work, like heart disease or lung cancer, you may have trouble qualifying for worker’ comp. The laws in some states rule out coverage for these “ordinary diseases of life.” Elsewhere, you may have to meet especially strict requirements for proving that your job was to blame for your condition. The insurance company will probably insist on an independent medical exam, and your right to benefits could come down to competing medical reports.

Repetitive or Cumulative Injuries

Many jobs require workers to do the same physical actions over and over. Most people are aware of carpal tunnel syndrome or other repetitive stress injuries that develop from prolonged use of a keyboard or computer mouse. But employees in a wide range of jobs can develop a variety of painful, even debilitating, conditions as a result of repeated micro-movements, lifting, or awkward postures. Other employees who work in noisy environments may develop hearing loss.

Besides carpal tunnel, some common repetitive injuries include:

  • back pain
  • tennis elbow
  • tendonitis
  • bursitis, and
  • trigger finger.

Often called cumulative trauma injuries, these conditions are usually covered by workers’ comp. Here again, it may be difficult to prove that your work was the cause—rather than other activities in your life—and the insurance company may deny your claim at first. But our survey of repetitive stress injuries in workers’ compensation showed that 75% of injured employees eventually received a settlement or award, even though nearly half of those people were initially denied benefits.

When Work Activities Aggravate a Preexisting Condition

Even if you had a pre-existing condition, you may still be able to receive workers’ comp benefits if more recent work activities or exposure aggravated the problem. For example, you may have had childhood asthma that was controlled but then flared up as a result of exposure to dust or chemicals on the job. Or maybe you had an old back injury from a car accident that was wasn’t causing you trouble—until it got worse when you had to lift heavy objects every day at work.

Although workers’ comp typically covers aggravation of preexisting injuries, some states may reduce certain benefits (such as permanent disability awards) to account for the role of the old injury or illness in your current medical condition.

What to Do If You Have a Chronic Condition

Take the following steps if you think you have suffered an occupational illness or work-related chronic injury:

  • Seek medical attention. First and foremost, you should take care of yourself by getting proper medical attention. Other than emergency care, you will have to follow your state’s rules for selecting a treating doctor for workers’ comp.
  • Report your injury. You should report your injury to your supervisor as soon as you realize that your condition was caused by your work. Each state has different time limits for reporting work injuries, which typically range from 30 to 90 days. But the deadline may be as short as a few days in some states, so you should make your report (preferably in writing) as soon as possible.
  • File a workers' comp claim. Depending on your state’s rules, you may need to file a workers’ comp claim with the state agency. In other states, your employer or doctor may be responsible for taking care of this.
  • Follow up. See our tips for collecting workers’ comp benefits to learn about other steps you can take to maximize your chances of receiving compensation.
  • Consider hiring an attorney. As we’ve explained, it can be particularly complicated to prove that your chronic condition is work related, especially if you have a preexisting condition, an illness that could be considered an ordinary disease of life, or a cumulative injury that could be blamed on age or recreational activities. An experienced workers’ comp lawyer can evaluate your case, deal with the insurance company on your behalf, and make sure that you get all the benefits you deserve. Learn how to find and choose the best workers’ comp lawyer for your case.
From Lawyers  By Sachi Barreiro, Attorney, University of San Francisco School of Law | Updated by E.A. Gjelten, Author and Editor

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