Hassle-Free Health Coverage: What Does Comp Cover?

As mentioned before, workers' compensation coverage applies to bodily injuries and diseases "arising out of and in the course of employment." Covered losses must be work-related (losses that are nonwork-related are not covered by workers' compensation).

Any covered injury must be accidental, and that term includes death resulting from the accident.

Only occupational diseases unique to the occupation are covered. A cause-and-effect relationship must exist between the job and the disease, and ordinary diseases suffered by the general public are not covered.

The laws commonly require that higher benefits be paid for certain losses as a penalty to the employer. Benefits are often increased if a loss results from the serious or willful misconduct of the employer (for example, failing to provide required safety equipment).

A number of states require that double benefits be paid for injury to a minor who is employed illegally. These extra payments are not covered by a workers' compensation policy, and the additional amount must be borne by the employer.

The cumulative effect of two injuries combined can be greater than the effect of the same two injuries in isolation. Example: An employee who loses sight in one eye would still be able to function in many jobs. If that employee suffered a subsequent injury causing loss of sight in the other eye, the disability would be greater than if the first injury had not occurred.

Once a person has been incapacitated, there is a greater risk that an additional injury may lead to permanent total disability, requiring higher statutory benefits than might be expected for the second injury alone.