Is Your Injury Work-Related? How to Prove Your Claim

Important: We updated this article in November 2023 to make sure all info below is as accurate as possible. To qualify for workers’ compensation benefits, you must prove you have a work-related injury or illness. But if you already have a preexisting injury, then it may be harder for you than for others. (Preexisting conditions are one of the top reasons for denied workers’ comp claims.) Occupational Safety and Health Administration (OSHA) guidelines help define what is considered work-related (or not) for filing claims, so let’s start there.

How OSHA Defines Work-Related Injuries and Illnesses

OSHA’s detailed guidelines explain what does and does not count as “work-related” for those filing workman’s comp claims. Let’s explore some examples that show these key differences in what counts and what doesn’t. First, an employer must find it a work-related injury or illness if a workplace event or exposure during working hours:

• caused or contributed to your injury or illness
• significantly aggravated a pre-existing injury or illness

The government defines work-related events or exposure as “the establishment and other locations where one or more employees are working or are present as a condition of their employment.” Your work environment includes not only physical locations, but also equipment or materials you must use to complete your own job tasks.

What Doesn’t Count as a Work-Related Injury or Illness?

Any workplace injury or illness not covered under workers’ compensation claims usually falls under OSHA’s exception list. We’ve listed helpful examples after each exception listed below.

Exception #1: You were visiting your workplace in a non-employee role when the injury/illness occurred.

For example: You work waiting tables at a restaurant and take friends there to eat on your day off. While there, you slip on ice from a spilled drink and dislocate your arm. This injury happened outside of the employee’s assigned working hours, and while clocked out. Since OSHA defines this as a non-work-related event, you won’t qualify for workers’ comp benefits.

Exception #2: Your injury/illness symptoms begin while you’re in your work environment, but the cause is not related to your job duties.

For example: Your child goes home from school early with a fever. You also develop a fever several hours later at work, then test positive for influenza. While you initially felt sick at your job, it counts as a non-work-related condition. In other words, you cannot file for workers’ comp if you get sick while at your job, but not directly because of your work duties.

Exception #3: Your injury/illness happens during voluntary participation in a wellness program or medical, fitness, or recreational activity held at your employer’s premises.

This exception applies to any activities an employee voluntarily participates in that’s not required as part of their job duties. Some example situations that may occur in your work environment where all participation is 100% voluntary may include:

• Blood drives
• Physical exams by a licensed health care professional at your annual wellness fair
• Volunteering events
• Annual flu shot
• Taking an exercise class or self-defense course
• Holiday parties/potluck lunches
• Charity fundraisers/toy drives

Exception #4: You get food poisoning after eating, drinking, or preparing your own personal food/drink within your work environment.

For example: If you choke on a snack you brought for your own personal consumption at work, then it’s not a work-related injury. What if you cut your finger while preparing food to eat on your break? That’s not work-related, either.

However, there’s one exception to this rule. If ingesting food contaminated by something in your workplace makes you sick, you can apply for workers’ comp. Workplace contaminants can include things like airborne particles, toxins, smoke, chemicals, etc.

In addition, if eating food supplied by your employer makes you sick, it’s work-related.

Exception #5: Your injury or illness results solely from doing personal tasks unrelated to your job or outside your regular working hours.

For example: You’re shaving in the work bathroom before your shift and accidentally cut yourself. Or, you’re straightening your hair after you clock out and burn your hand. These are not considered work-related injuries, even though they occur while at your employer’s establishment. Personal grooming tasks are not part of your routine job duties, so they cannot qualify for workman’s comp.

Important: Car crash injuries almost never qualify for workers’ compensation benefits. If a motor vehicle accident in a company parking lot injures you, then might get workers’ compensation. Your car crash won’t count as an occupational event unless you’re driving as part of your required job duties.

Even Uber or Lyft drivers aren’t guaranteed workers’ compensation for car accident-related injuries. Driving a work vehicle down the company access road and another driver hits you? Company car drivers aren’t guaranteed workers’ comp benefits, either.

What About Occupational Injuries or Illnesses That Happen While Working From Home?

Working from home is much more common now thanks to the pandemic. This means you could have a workplace injury your own house or somewhere else. Occupational diseases and injuries that happen while working remotely must meet certain requirements to qualify for workers’ comp. Work-related means any injury or illness that happens to someone while performing an employee’s work duties. But if your home environment or another setting directly injures you, then you cannot get workers’ comp.

OSHA examples of occupational injuries at home:

• You drop a heavy box of work documents at home and injure your foot. This case counts as work-related when applying for workers’ compensation.
• You’re altering a garment on your home sewing machine and get an infection after the needle punctures your fingernail. Since you own a tailoring business and need medical treatment, this counts as a work-related injury.

OSHA injury examples while working from home that are not work-related:

• You trip over your dog while rushing to answer a work call at home and sprain your ankle. This injury does not qualify for workers’ comp.
• You go to the hospital for smoke inhalation after faulty wiring sparks a fire in your house while working from home. This is not an occupational injury.

Get Free Expert Help With Your Work-Related Injury Claim

Still not sure if you qualify for workers’ compensation? If you have a pre-existing condition or work remotely full-time, it’s always a good idea to consult a lawyer for free first.

Workers’ comp lawyers in our network offer free, private consultations over the phone. You can sign up for a free, no-obligation phone call and get confidential advice that applies to your specific situation.

Want to speak to someone for free about your claim? Click the button below to start your free online benefits quiz now and see if you may qualify:

Get Your Free Benefits Evaluation