What Injuries Qualify for Workers' Comp?

Workers’ compensation is an insurance system used by businesses in all 50 states to compensate their employees who suffer injuries at work or who become ill because of exposure to toxic substances. The system is no-fault based, meaning that neither employee nor employer can sue the other over any such occurrence at work. 

If you need to file for workers’ compensation—or file an appeal for a denied or canceled claim—in or around Metairie or anywhere else in the state, contact us at the Law Office of Bruce C. Betzer. We have been helping employees claim what’s due them under workers’ compensation for more than a decade. We will help you assemble the needed documentation and evidence to push your claim forward, but remember, you must report your injury or illness to your employer within 30 days. 

The Law Office of Bruce C. Betzer proudly serves clients not only in Metairie but also throughout Chalmette, New Orleans, Jefferson Parish, and St. Tammany Parish. 

Overview of Workers’ Compensation in Louisiana 

Workers’ compensation provides a broad range of benefits for those injured at work or in work-related activities. The operating phrase for determining if your injury or illness qualifies is if the accident or onset occurred during “the course and scope of your employment.” Generally speaking, if something happens while you’re in the workplace or on a work-related assignment, then you will be covered, with a few exceptions. 

However, if you’re driving to and from work and you’re injured, you will not be covered (unless you're in a company car). If you are sent out on a work-related assignment in your vehicle, you will be covered. Anything that falls within “the course and scope of your employment,” even including mandatory off-site meetings or parties, will typically be covered. 

In Louisiana, in general terms, any business with one employee and whose payroll is at least $3,000 must carry workers’ compensation insurance, which is available from insurance companies. This includes those firms that only hire independent contractors and those businesses only hire a few part-time employees. There are some exemptions, however, covering businesses engaged in the oil and gas, entertainment, and airline industries.  

Workers’ compensation can compensate the injured or ill employee for medical and related expenses, ongoing care costs, lost wages due to time missed from work to recover, temporary or permanent cases of disability, and funeral expenses. It's important for employees in Louisiana to understand what injuries can potentially qualify for worker's comp, and what injuries will not.

Note, however, that lost wages are paid at only two-thirds of your average weekly wages with a statewide cap in place. There is also a time frame for the number of days you missed work before you can be compensated. You must be out seven days before lost-wage compensation is possible, and payment for those seven days will only be available if you miss 14 or more days of work. 

Injuries That Qualify for Workers’ Compensation 

Virtually any injury falling under the course-and-scope requirement should be covered under workers’ compensation. These injuries can include slips and falls, machinery malfunctions resulting in injuries, being struck by a dropped or flying object, and more. Even illnesses resulting from exposure to a toxic substance at work – which can even include cleaning fluids – should be covered. 

Another category to consider is repetitive stress injuries. The most talked-about injury in this category is carpal tunnel syndrome, which can result from as simple an everyday task as entering data into a computer by typing on a keyboard. It can also result from other routine tasks, including ringing up sales on a cash register or stocking shelves in a retail establishment. Other repetitive stress injuries can result from operating a jackhammer or using other equipment on a regular basis. 

Injuries That May Not Be Covered 

In addition to non-coverage for anything that happens when you’re offsite and not engaged in work-related activities—even leaving the premises for your lunch break—you may also lose coverage under other circumstances. If you are drunk or high on a controlled substance, you likely won’t be covered. Also, if you engage in a tussle with a co-worker and are injured, you likely won’t be covered. 

Benefits Available 

Worker's comp benefits are critical in order to help you move forward after an injury. Your medical and related expenses, including for long-term care, will be covered under workers' compensation. Lost wages, subject to a state cap and a two-thirds formula, should be paid once you’ve missed enough days from work. 

If your injuries render you disabled, workers’ compensation has two categories for covering your medical and treatment expenses and compensating you for lost wages – temporary and permanent. Your disability will also be categorized as either partial or total, which will affect the benefits you qualify for. 

Funeral expenses are also covered for any employee who loses their life because of a workplace accident or condition. Keep in mind that what workers’ compensation does not pay for is compensation for an injured or ill worker’s pain and suffering. 

Filing for Workers’ Compensation 

The first step in the workers’ compensation claims process is notifying your employer. You have 30 days from the time of your injury or illness to do this. The employer then has 10 days to notify the state Office of Workers’ Compensation. As for the claim with the insurance company, that needs to be handled swiftly and according to their requirements. 

Legal Guidance You Can Trust 

Insurance companies are for-profit enterprises, so you can expect that any claim you file will be scrutinized closely and often challenged. The insurer and their representatives may demand further medical evidence or other documentation. Even if your claim is approved, down the road, the insurer may question your ongoing need and seek an independent medical examination (IME) with a physician they choose. Your benefits could be cut or eliminated altogether, and you may need to file an appeal. 

Reach out to us at the Law Office of Bruce C. Betzer with all your workers’ compensation questions and concerns. We can help you assemble the evidence and other materials needed to back up your initial claim—and we can also help you file an appeal if your claim is denied or later rescinded. We proudly serve clients in Greater New Orleans from our office in Metairie. Set up a consultation today.