Workers’ Comp: What Isn’t Covered in Ohio

Workers' Comp: What Isn't Covered in Ohio

Most Ohio workers and employers generally understand that Workers’ Compensation insurance covers medical costs and other expenses related to injuries an employee sustains on the job. Workers’ comp covers a wide range of injuries and incidents at work, from burns and crush injuries to carpal tunnel syndrome and asbestosis.

Occasionally, however, clients of Dworken & Bernstein want to know what isn’t covered by Ohio workers compensation. That is the subject of this blog post.

What Isn’t an “Injury” Under Ohio Workers’ Comp Law

The Ohio workers’ compensation statute defines what constitutes a covered injury very broadly. An injury “includes any injury, whether caused by external accidental means or accidental in character and result, received in the course of, and arising out of, the injured employee’s employment.” There are, however, four categories of injury that aren’t covered by workers’ comp insurance. We summarize each below.

Psychiatric Conditions

The law cautions that psychiatric conditions are not covered by workers’ comp unless:

  • “the claimant’s psychiatric conditions have arisen from an injury or occupational disease sustained by that claimant”; or
  • “the claimant’s psychiatric conditions have arisen from sexual conduct in which the claimant was forced by threat of physical harm to engage or participate.”

In other words, the only time a mental health problem, alone, is covered by workers’ comp, is when it arises from a sexual assault at work. In all other circumstances, a mental health problem will only be covered if it’s caused by a separate, covered “injury.”

“Natural Deterioration”

We all age, and as we do, we suffer some amount of physical decline. Workers’ compensation is not insurance against aging, of course. That is why the law excludes from workers’ comp coverage “injury or disability caused primarily by the natural deterioration of tissue, an organ, or part of the body.” In some cases, it may take significant medical examination and analysis to determine whether a condition is the result of “natural deterioration” or from a circumstance directly tied to the workplace. Any worker who has had a claim denied as mere “natural” physical “deterioration” should consult with an experienced workers’ comp attorney, as should any employer concerned about the applicability of this exclusion from workers’ comp coverage.

Company Softball Games, Etc.

Many employers encourage employees to participate in company-related recreational and fitness activities. When employees join in, any injuries they sustain in the activity will not be covered by workers’ comp “if the employee signs a waiver of the employee’s right to compensation or benefits [under workers’ comp] prior to engaging in the recreation or fitness activity.” Given this provision, employers who sponsor a company softball team would be well-advised to ensure they seek waivers from employees before the first pitch.

Pre-existing Conditions

Workers’ comp is also not insurance against injuries that existed before the employee arrived at work. For the workers’ compensation system to remain viable, only injuries actually sustained at work can be covered. However, if a workplace injury “substantially aggravates” a pre-existing condition, then the “substantial aggravation” falls within the definition of covered injury under workers’ comp. To avoid someone trying to take unfair advantage of this rule, the law provides that the substantial aggravation “must be documented by objective diagnostic findings, objective clinical findings, or objective test results.” An employee’s “subjective complaints” may constitute evidence of the aggravation, also, but they are not enough on their own to prove it.

NE Ohio Workers’ Comp Attorneys

Dworken & Bernstein advises Northeastern Ohio employers and employees alike on a wide range of workers’ compensation-related matters. If you have questions about whether a workplace injury is covered by workers’ comp or any other legal question about injuries in the workplace, contact us today.

The information presented in this post is not legal advice and does not form a lawyer/client relationship. Laws and circumstances can differ and change.
Please contact us for a personal review of your situation

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