A compensable claim refers to an injury or illness directly related to the work you, the employee, performs. If you file a claim that’s not considered compensable, it might be delayed or denied for not meeting the necessary requirements.
Must Occur in the Course and Scope of Employment
For a worker’s compensation claim to be compensable, the injury or illness must occur while the employee performs their job duties and be directly connected to the tasks you were hired to perform.
Examples of Compensable Claims
- Traumatic Injuries: Sudden injuries caused by accidents in the workplace, such as slipping on a wet floor, being struck by equipment, or sustaining a fall from scaffolding.
- Repetitive Stress Injuries: Injuries that develop over time from repetitive motions, like carpal tunnel syndrome from typing or chronic back pain from frequent heavy lifting. These injuries are compensable as long as the employee can show that work activities were a substantial contributing factor.
- Occupational Diseases: Long-term exposure to hazardous conditions in the workplace can lead to illnesses such as lung disease from inhaling toxic chemicals, hearing loss from constant loud machinery, or skin conditions from exposure to harmful substances.
- Mental Health Injuries: Qualifying mental health conditions, such as post-traumatic stress disorder (PTSD), may also be compensable. For instance, a worker who experiences a traumatic event at work, such as witnessing or being involved in a violent incident, may develop PTSD as a result.
Examples of Non-Compensable Claims
- Personal Activities at Work: The claim is unlikely to be compensable if an employee sustains an injury while engaged in an activity unrelated to their job, such as lifting heavy boxes for personal reasons during a break.
- Pre-Existing Conditions Not Aggravated by Work: If an employee has a pre-existing condition and the work activities do not substantially aggravate or accelerate that condition, the claim may not qualify for workers’ compensation.
- Injuries Outside the Scope of Employment: Injuries that occur during off-duty activities or recreational events not related to work, such as a company-sponsored picnic or a personal errand run during lunch break, are typically not compensable unless the employer requires participation.
In each example, the determining factor is whether the work activity substantially contributed to the injury or condition.
Must Be Supported by Proper Documentation and Medical Evidence
As soon as an injury happens, it’s of the utmost importance that employees begin documenting anything and everything that might be relevant to proving the claim is compensable.
Examples of that documentation include:
- First Report of Injury (FROI): After the employee informs the employer about an injury, the employer must submit an FROI to the workers’ compensation insurer.
- Medical Reports: To link the injury and work activity, workers need a comprehensive medical examination and proof of the diagnosis and treatment plan to establish a connection between the injury and the employee’s work duties. Examples include doctor’s notes, hospital discharge summaries, and therapy or rehabilitation records.
- Accident Reports: Any internal reports or forms filled out at the time of the incident help document the circumstances of the injury.
- Witness Statements: If other employees or supervisors witnessed the injury, their statements may help strengthen the claim.
- Photos or Video Evidence: Pictures/ security camera footage of the accident scene and injury can further support a worker’s compensation benefits claim.
- Communication with Employer/Insurer: Copies of emails, texts, or letters to the employer or workers’ compensation insurance company should be included in the employee’s claim documentation.
Read Our Step-by-Step Guide to Report a Work-Related Injury
Fault in Minnesota Workers’ Compensation Claims
Minnesota’s worker compensation operates on a no-fault basis.
Basically, this means that you are not required to show that your employer was negligent or that unsafe work conditions caused the injury. This rule exists to protect you– Your employer cannot deny a claim by arguing that your own actions or negligence caused the injury.
So, for example, if a worker walking to their desk trips on their shoelaces, they are still eligible for compensation. The same rule applies if someone suffered a back injury from improper lifting techniques while picking up boxes or burned themselves on the stove while cooking in a restaurant.
However, there are a few, very obvious exceptions:
- An employee intentionally causes their own injury
- If the injury was caused by the employee’s intoxication from drugs or alcohol at the time of the incident
- Injuries that occur during voluntary social or recreational activities, like company picnics or holiday parties, are typically not covered unless the employer requires participation as part of the job.
This structure gives employees the opportunity to to receive timely benefits without the need for lengthy legal battles over who was at fault for the injury.
Recieve a Denial of Primary Liability Letter? Learn What It Means and What to Do Next
