Determining if an Illness or Disease is Compensable Under Workers’ Compensation

With the recent ebola outbreak getting closer and closer to home, we thought it was the perfect time to discuss illnesses and diseases and how they are classified under workers’ compensation. In order for an illness or disease to be occupational and compensable under workers’ compensation, two conditions must be met.

  1. The illness or disease must be occupational. This means that it must have risen out of the scope and course of employment
  2. The illness or diseases must be caused by or arise from conditions that are peculiar to the work.

For the first condition- the simplest way to know if it is satisfied is to ask whether or not the employee was benefiting the employer at the time they were exposed to the disease or illness. While it varies state to state, this condition is the easier one to meet.
For the second condition, if the illness or disease is not peculiar to the work, then it is not compensable under workers’ compensation. For example, a case in which disease is peculiar to the work would be if a healthcare worker contracted an infectious disease due to contact with infected blood.
There is no single test that can be applied to every case, as they differ and must be judged separately, and the facts surrounding the sickness, as opposed to the disease or illness itself, are often investigated in order to separate opinion from fact. Physicians will often investigate things such as the whether or not the illness is common to the industry, medical history and personal habits of the individual, the timing of the symptoms in relation to work and whether or not co-workers show similar symptoms.
The process of determining whether or not a claim in compensable under workers’ compensation can take years, as it is often dragged out by the time it takes to compile facts, medical evidence and history, and compare the case with others. In short, unless you can prove that an illness is peculiar to a job, the illness is not compensable under workers’ compensation.
To learn more about workers’ compensation and to ensure that you’re protected, click here.