Injury or Illness: Is There A Difference for Workers Comp?

The distinction between an injury and a disease may seem trivial, but it’s of the utmost importance in any Utah workers compensation case, and can determine whether you receive full or partial benefits from your claim.

Here, we’ll discuss the differences between injuries and illnesses to help you make sure that you file the proper workers compensation claim.

A Tale Of Two Claims

In the case of a disease, Utah state law says that costs should be apportioned according to their cause. Apportionment means a court will break down your medical costs by percentage, and only give you workers compensations benefits from the portion of your disease that relates to your employment.

This is designed to fairly compensate workers while protecting employers from having to pay for medical costs unrelated to employment, such as those that come from medical conditions that the employee had before working for the employer.

However, if you are injured and you file an industrial accident claim, Utah law says that you should receive full benefits if the injury is found to have stemmed from work. Even if your injury aggravated a preexisting condition, you are entitled to full benefits. That means there is no apportionment in industrial accident claims.

Industrial accident claims may entitle you to full benefits, but you must prove that employment was the cause of your injury. If you cannot prove this, you will receive no benefits.

Common Sense Distinction

In the past, these two types of claims (disease and injury) were filed in a fairly common sense way. If you were injured at work in an accident, such as one involving machinery, you would file an industrial accident claim and be entitled to full benefits if this accident was caused by employment.

If you developed medical problems over time that were partly caused by employment, you would file an occupational disease claim. For example, if your work involved heavy lifting and over time you developed chronic shoulder issues, you would file an occupational disease claim.

However, the line between the two types of claim has become increasingly blurred in recent years. This is because, in the 1940’s, Utah made it very difficult to file occupational disease claims. This led to courts expanding the scope of industrial accident claims to cover many of the occupational disease claims that could no longer be filed. So courts began treating chronic diseases such as knee issues and back pain as industrial accidents.

Since nearly every claim made today in Utah workers compensation cases is an industrial accident claim, apportionment is uncommon. Even if your injury is back pain caused by heavy lifting over a thirty year career, your attorney will likely have you file an industrial accident claim, despite the fact that there was no accident involved in your medical condition.

A Change That Has Not Helped Workers

This may seem like it benefits workers. After all, apportionment means that employees only receive partial benefits. However, that is not the case. Apportionment allowed for workers to receive partial benefits in cases where they otherwise may not receive any.

Remember, with industrial accident claims, the burden of proof is on the employee show that their injuries were caused by employment. If they cannot do this, they are awarded no benefits.

With occupational disease claims, the employment is already assumed to be a cause of the worker’s condition. This lowers the standard of proof to earn workers compensation benefits. Although the maximum compensation the employee earns could be lower, an occupational disease claim can make it easier to earn benefits.

There have been some steps to clarify this distinction in recent years. In the early 1990’s, there was an attempt to pull back the restrictions placed on occupational disease claims. Although this was a promising step, courts have not followed through by implementing this widely. That means that in Utah today, most claims that are filed are still industrial accident claims.

Helping Employees and Employers

More clearly defining industrial accidents and occupational disease allows courts to fairly determine what an employee is owed in the case of medical costs related to employment. It lowers the standard of proof for workers with chronic conditions, which can be difficult to directly link to employment, helping them receive the benefits that they are entitled to.

By bringing back occupational disease claims, workers will have more legal options when seeking benefits, and employers will not be liable for medical conditions unrelated to employment.

A Utah Workers Compensation Lawyer You Can Trust

At Davis and Sanchez, we have years of experience working on Utah personal injury cases. Whether you have been injured in an industrial accident or have a chronic condition related to employment,  We fight so that our clients receive the maximum benefits they are entitled to. Contact us today for a free case evaluation.