Eligibility for Workers' Compensation


How do I know if my injury is considered "work-related"?

Am I eligible for wage loss benefits?

When and where am I covered?

Is every injury that happens at work covered?

Am I covered when I am traveling?

Are recreation or social activities covered?

What if I have a preexisting condition?

Are occupational diseases covered?

What if I retire from my job while on workers' compensation?
 

How do I know if my injury is considered "work-related"?
Michigan is a "wage loss compensation" state. Establishment of an injury or occupational disablement is only the first step.  For specific injuries, Section 301 of the Workers' Disability Compensation Act states the following:

An employee, who receives a personal injury arising out of and in the course of employment by an employer who is subject to this act at the time of the injury, shall be paid compensation as provided in this act. A personal injury under this act is compensable if work causes, contributes to, or aggravates pathology in a manner so as to create a pathology that is medically distinguishable from any pathology that existed prior to the injury. In the case of death resulting from the personal injury to the employee, compensation shall be paid to the employee's dependents as provided in this act.

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Am I eligible for wage loss benefits?
In order to be eligible for wage loss payments in Michigan, a worker must show that the disability has caused a loss of wage earning capacity in work suitable to his or her qualifications and training. The amount of compensation received will be directly related to the amount of wage loss which will take into account any residual wage earning capacity.  According to Section 301(4)(b) of the Act, "wage earning capacity" means the wages the employee earns or is capable of earning at a job reasonably available to that employee, whether or not wages are actually earned.

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When and where am I covered?

Workers' compensation is designed to provide benefits to workers whose injuries "arise out of and in the course of the employment." In the majority of cases it is obvious whether an injury happened at work. Injuries may occur any time of the day or night, and your employer should have instructions for reporting injuries no matter the time. There are, however, times when the relationship between the job and the injury will be questioned.  The bottom line is this: work must be the cause of the disability.  If you simply come down with the flu while on the job, you are probably not entitled to workers' compensation benefits.

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Is every injury that happens at work covered?
The courts have recognized that a certain amount of horseplay is to be expected on most jobs and that if a worker is injured as a result of such horseplay, that injury is compensable. The courts have also held, however, that there is a limit to this situation. If you are injured as a result of your "intentional and wilful misconduct," you are not entitled to benefits. The courts have held that if an injury results from a violation of a rule which is clearly announced and regularly enforced by the employer, the worker is not entitled to workers' compensation benefits.

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Am I covered when I am traveling?
Generally speaking, if you are injured on the way to or from work, your injury is not covered. If, however, you are on your employer's premises when injured, then you are covered. If your job or assignment requires you to travel, you are covered while traveling. However, if the injury occurs while you have “deviated” from the business travel, your injury may not be covered.  Each case is unique, and several factors can be applied to determine whether the injury of an employee who was traveling on business arose out of his or her employment.

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Are recreation or social activities covered?
Section 301(3) of the Act provides that if an injury results from an activity, "the major purpose of which is social or recreational," it is not covered under the Act. If you are injured during a company picnic or an office Christmas party, your injury is probably not covered. This may, however, depend upon specific circumstances.

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What if I have a preexisting condition?
If a person has an incident at work that causes him or her to become disabled, the worker may be entitled to benefits. A preexisting condition such as mental disabilities, conditions of the aging process, degenerative arthritis, and heart/cardiovascular conditions, may be compensable if the underlying pathology is aggravated or accelerated by employment to create a medically distinguishable condition. There are some special rules for the conditions listed above.  In cases of heart disease, mental disabilities, and conditions of the aging process, you must prove that the employment aggravated or accelerated your condition in a significant manner. In cases of mental disability, the condition must be caused by actual events of employment.

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Are occupational diseases covered?
Yes.  According to the workers’ compensation statute, “Personal injury includes a disease or disability that is due to causes and conditions that are characteristic of and peculiar to the business of the employer and that arises out of and in the course of the employment.”  Another way to describe these might be injuries or diseases that arise over time.  Remember, the key with any injury is that it must be attributable to work.  For example, the statute goes on to state that, “An ordinary disease of life to which the public is generally exposed outside of the employment is not compensable.” 
There are certain occupational diseases (and now injuries in certain industries) that are treated specially. Silicosis was a very frequent disease among foundry workers. When occupational diseases began to be covered by the law, there was concern that the foundry industry would go out of business if they had to pay full compensation. Accordingly the law was changed to provide special protection under those circumstances.
Under the present law, if you suffer from certain dust diseases or receive an injury while performing certain work in the logging industry, you receive exactly the same benefits as if the injury had occurred in some other way, but your employer receives special protection through reimbursement from a special fund to which all Michigan employers contribute.

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What if I retire from my job while on workers' compensation?
Section 373 of the Act contains a special definition of disability for retirees. A person is considered a retiree if he or she is receiving a pension or retirement benefit (but not a disability pension) that was paid for by the employer. To be considered disabled and have a loss of earnings or wage earning capacity,  a retiree must prove that he or she is unable "to perform work suitable to the employee's qualifications, including training or experience."  While wage loss may not be paid, the retiree may still be eligible for medical benefits..

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