Injuries That Qualify for Workers’ Compensation

Workers’ compensation is an insurance program that requires employers to provide medical coverage—and sometimes compensation for lost wages—to employees who are injured on the job or fall ill due to workplace conditions, such as the use of toxic chemicals. 

Although there is a state-funded Department of Workers’ Compensation in the Commonwealth of Kentucky, employers are required to cover any benefits paid under the system. Most employers do this through buying commercially available workers’ compensation insurance.

The system is designed to prevent costly and lengthy lawsuits between employees and employers. It is a no-fault program, meaning no one is usually assessed the responsibility or blame for what happened. There is an exception if a third party is responsible for the injury or illness, such as a faulty piece of machinery or a toxic substance without safety instructions, but such cases may be limited at most places of work. 

The general standard for what qualifies as an injury or disease under workers’ compensation is that it must be work-related and occur at a work site or other authorized location where employees do some function of their job. If you’re injured driving to work, you likely won’t have a workers’ compensation claim unless you were pursuing some goal related to work, such as stopping somewhere to pick up something needed and requested by your employer.

If you or a loved one has been injured or fallen ill at work in or around Louisville, Kentucky, and you have questions or concerns about how your claim is being treated or ignored, reach out to the workers’ compensation attorneys at the Slechter Law Firm, PLLC.  

The husband-and-wife team of Mr. and Mrs. Slechter will work personally with you to help you resolve any issue you have or file an appeal if you feel your claim has been denied or later canceled unjustly. We also serve clients in Lexington and throughout the state. 

Brief Overview of Workers’ Compensation in Kentucky

In Kentucky, some businesses are exempt from having workers’ compensation coverage, such as agriculture concerns, domestic workers employed in private homes, and members of religious organizations that oppose the program. Otherwise, any employer with even a single employee must provide workers’ compensation. Employers can self-insure, but most contract with a private insurer. 

As mentioned earlier, the system is based on no-fault and arose across the nation in response to potentially costly and lengthy legal battles between employees and employers, with each side blaming the other. In the Commonwealth, however, employees can voluntarily opt out of workers’ compensation, thus giving them the right to sue their employer for negligence and other causes.  

This can be done by filing a Form 4 Waiver with the Department of Workers’ Compensation. 

Kentucky law, however, prohibits employers from requiring employees to sign a Form 4 Waiver as a condition of employment. The forms must be signed voluntarily to be valid. Employers face penalties for trying to require Form 4 compliance. 

Injuries and Illnesses That Qualify for Workers’ Compensation Benefits

Construction sites are a common source of workplace injuries. Workers fall from scaffolding, get struck by objects or vehicles moving around the site, have machinery and tools malfunction on them, and get exposed to burns and electrical shocks. 

In general, however, workers’ compensation will cover any injury or illness resulting from workplace conditions and job-related requirements. In other words, if coworkers get in a spat and wail on each other, that is not going to be a workplace-related injury situation. 

For the most part, workers’ compensation covers: 

• Any work-related accident or injury, which includes paying for any required medical treatment and perhaps for lost time from work under qualifying conditions 

• Illnesses that result from exposure to harmful chemicals or allergens; asbestos is probably the most widely-known of these toxic substances, so much so that it has now moved beyond workers’ compensation when the employee suffers mesothelioma. In Kentucky, the most common occupational disease is coal workers’ pneumonoconiosis, or black lung disease. 

• Repetitive stress injuries are also common, resulting from repeated activities like sitting at a computer keyboard and entering data all day at work, causing carpal tunnel syndrome. 

Injuries Not Covered

Any injuries resulting from horseplay, or as noted above, disputes among employees, or from alcohol and drug usage on the job, will generally not qualify for workers’ compensation. Injuries or illnesses sustained outside the work environment and not when doing company-related activities also will not likely be covered. 

How Long Will Benefits Last?

Medical and treatment expenses will be covered until the worker recovers or the attending physician reports that the worker has reached the point of maximum medical improvement (MMI) and will not get better.  

In that case, the benefits will depend on whether the resulting disability is considered partial or total. Benefits for Permanent Partial Disability (PPD) will continue for up to 520 weeks. Benefits for Permanent Total Disability (PTD) will continue until the age when Social Security kicks in.  

Benefits include medical care and lost wages, but lost wages are generally paid at two-thirds of your average weekly wage, with a statewide cap in place. The wage replacement formula is complicated as the percentage of impairment is also factored in, which can result in an even lower lost-wage benefit. 

Making a Workers’ Compensation Claim

If your injury or illness is readily apparent, you should seek medical evaluation immediately and also report the injury or illness to your employer. You are free to choose your own physician provided your employer has not chosen a Managed Care Physician group. In that case, you will have to use a physician from in the group, but you can change that physician once subsequently, so long as the new one is also in the group. 

Injuries and illnesses are not all readily apparent, however. Some diseases take time to reveal themselves, and repetitive-stress injuries also may take months or years to take their toll. Kentucky does impose time limits. For injuries, you have two years to file a claim with the Department of Workers’ Claims.  

For occupational diseases, claims must be filed within three years of diagnosis or after symptoms first appeared, whichever is earlier. The maximum period to file is five years after the worker was last exposed to the cause of the disease. 

Injured at Work? Contact the Slechter Law Firm, PLLC

As you can see, making a claim and justifying it can sometimes be challenging. Insurance companies are for-profit institutions, known to put claimants through the wringer to justify their injury or illness. They can even order an independent medical evaluation (IME) with a physician or group of their choosing, meaning they basically work for the insurer. 

If your claim is running into challenges and difficulties in or around Louisville, or anywhere in Kentucky, contact the legal team at the Slechter Law Firm, PLLC. Mr. Slechter and Mrs. Slechter will handle your case directly and personally. Reach out immediately.