When you’re injured on the job, it is a fairly straightforward process to recoup costs to treat the damage.
But what happens when your job makes you sick?
For chronic illnesses caused by a job, there’s a more complex and often ambiguous path to getting compensated.
Most on-the-job issues go through workers’ compensation, a type of insurance aimed at preventing litigation in the event of an injury or illness. The laws are governed by states.
Workers’ compensation provides wage replacement and medical benefits to a worker hurt on the job. With a workers’ compensation claim, the injured employee gives up their right to sue the employer for negligence.
Some state laws limit the amount an injured employee may collect. Some also eliminate coworkers’ liability for an accident.
According to the U.S. Social Security Administration, workers’ compensation payments totaled more than $61 billion in 2012. About half of that went to medical bills, while the rest went to lost wages and compensation to disabled employees and survivors of those killed on the job.
When Workers’ Comp Gets Complex
Eugene Hollander, an attorney based in Chicago, told Healthline that on-the-job injuries or illnesses are usually covered by a state’s workers’ compensation laws.
You must meet a few requirements to file for workers’ comp, noted Ken Kieklak, a Social Security attorney from Arkansas. In most cases, you must show you were working at the time of injury, show that it happened while you were working, and that it happened because of work, and that you sustained damages such as lost wages, loss of function, or medical treatment costs.
Kieklak told Healthline that receiving money under a workers’ compensation claim for a chronic illness depends on the condition, how it arose, and how long it lasts. It can be more complicated than a one-time injury.
“Some of the challenges involved can be the difficulty in showing proof of a job-related chronic illness versus a single tangible event that caused an injury at work,” Kieklak said.
“It would likely be easier to prove worker's compensation for injuring your hand on a printing press versus saying that ink fumes gave you some sort of cancer,” he added. “In the former scenario a tangible event has occurred of which the probable result is known and established. In the latter, a link between the chemicals used and the cancer would likely have to be established to show that the injury satisfied the program criteria.”
On occasion, an employee may claim their employer caused emotional distress and is responsible for damages. That claim would need to be filed within a certain period of time after the illness began, Hollander said.
“In some cases, illnesses such as depression can be manifested by a hostile work environment,” Hollander noted.
To receive compensation under the workers’ compensation law, a doctor would need to provide a diagnosis that the depression was caused by the workplace.
An Eight-Year Battle Continues
Sandra Cooper knows all too well the challenges involved in an illness-related claim.
Cooper’s husband, Gene, worked at a flooring factory in Pennsylvania.
She told the Center for Public Integrity (CPI) she filed a workers’ compensation claim 8 years ago, saying chemical exposure at her husband’s workplace damaged his brain.
Gene Cooper declined quickly, eventually living in a nursing home and doing little more than staring off into space. He died in 2014.
Four years after the compensation claim was filed, a judge ruled Gene Cooper’s illness was the result of chemical exposure on the job. That was after visits to eight doctors and more than a dozen tests.
However, Sandra Cooper is still trying to receive compensation for her husband’s medical bills as well as wages lost due to his illness.
CPI investigated Cooper’s case and concluded that workers’ compensation rarely gets approved for people who are made sick by their jobs.
In some cases, symptoms of a job-related illness take years to appear, and employees may not even know they are ill in time to make the filing deadline.
Complicating things, claimants have to prove an illness was caused by the job and not by other factors.
Illness claims in Ohio and Oregon, for example, are three times more likely to be denied than injury claims, according to CPI.
Denial by Bureaucracy of Paperwork
In addition to challenges in determining fault, the claim process itself can be a nightmare — even for a worker clearly injured on the job.
Ken Beckstead worked as a salesman in California during the 1990s. He was required to take time off work while being treated for an injury. He had to battle for compensation, even though his employer acknowledged his claim.
Beckstead’s work involved taking orders by hand. The company had been switching to computers one employee at a time.
“When they figured that we couldn't take orders as fast [on the computer], they made me continue to write orders by hand,” recalls Beckstead. “This lasted months and I started to have wrist problems.”
After visiting the doctor, he was diagnosed with tendinitis and showed signs of carpal tunnel syndrome. Beckstead’s boss made him take time off for physical therapy, which lasted for months. His employer even prepared the paperwork for compensation.
When Beckstead went to court to collect, his case was thrown out because the paperwork —which his boss had prepared — had not been completed correctly.
Beckstead’s attorney filed an appeal and won. His is now considered a landmark case.