Just because you were injured on the job doesn't necessarily mean that you have a valid workers compensation claim. To file a viable workers comp claim, your situation must meet certain general criteria, as well as any specific criteria applicable to the state in which you live and/or work.
Generally, your claim must meet three main criteria:
1. You must have had an accident while on the job OR you must have an occupational-related disease;
2. You must give timely notice of the accident or disease diagnosis to your employer; and
3. You must have medical documentation for evidence to prove that your injury or disease is the result of your work.
A "compensable" injury covered by workers compensation must occur during your employment and be related to or a result of your job. For example, if you're injured due to a fall off the top of a building while doing roofing repairs as part of your job, you have a valid workers comp claim. The injury clearly happened while you were performing a work activity.
But if you trip and break your leg as you're getting a sandwich across the street from the worksite, this injury may not be covered by workers comp, unless certain circumstances existed. For instance, if your supervisor asked you to go across the street from the worksite to get everyone lunch at the sandwich shop and you became injured, you could have a viable claim.
Occupational diseases also lead to valid workers compensation claims. Common work-related diseases include carpal tunnel syndrome, hearing loss from workplace noise exposure, mesothelioma from asbestos exposure and other conditions.
After you've determined that your injury or disease qualifies for a workers comp claim, you must ensure that you provide your employer with written notice of the accident or indication that a disease is work-related within 30 days. In many states, however, the 30-day timeframe isn't set in stone. You may still have a valid claim even if you didn't notify your employer in such a timely manner.
Finally, a valid claim must prove a "causal relationship" between the illness or injury and your job. For on-the-job injuries, you can prove a causal relationship by providing a doctor's medical report that includes a description of the workplace accident or event that led to the injury, a diagnosis of your condition and an explanation of how the diagnosis relates to the accident.
For occupational diseases, you must prove a causal relationship by submitting a doctor's description of your work, diagnosis of your condition and an explanation of how your work caused the condition. Psychological conditions are also sometimes covered by workers comp. In particular, post-traumatic stress disorder (PTSD) claims are usually valid when the stress or trauma is related to a workplace incident. For example, a police officer who witnesses his partner's death in the line of duty and begins to suffer from PTSD would likely have a viable workers comp claim.
Seeing a doctor as soon as possible is crucial to winning your workers comp claim, because these cases rely heavily on medical evidence. The more time that goes by before you seek medical attention, the more difficult it becomes to prove the causal relationship.
Because workers comp regulations vary state by state, you will likely need to meet further criteria beyond these basic three elements to have a valid claim. For example, the Worker's Compensation Act of Georgia restricts compensable claims to those made by a person who is an employee and not an independent contractor. Georgia also requires that the employer have at least three employees in order for workers comp to cover the claim.
