What Injuries or Illnesses Are Not Covered by Workers’ Comp?

Workers’ compensation was put in place to cover injuries and illnesses that happen in the workplace. There are limitations, though, and you should know what they are if you believe you’re entitled to workers’ comp.

For a workplace injury or illness to be covered by workers’ comp, it must have occurred while you were working. In other words, if your injury or illness happened outside of the workplace and is unrelated to your job, you’re not covered.

Workers’ compensation laws vary from state to state. Generally speaking, the workers’ compensation law in the state where your employer is based is the law that governs your case. Contact the workers compensation attorneys at Bell & Pollock P.C. for more information about workers’ compensation cases and state jurisdiction.

If You Are Injured at Work, File a Claim Immediately

As with most laws, a statute of limitations applies to workers’ compensation cases. If you think you have a workers’ compensation case due to a work-related injury or illness, notify your employer in writing as soon as possible.

Check your employee handbook for any reporting rules that apply to workplace injuries, or you could be disciplined for delaying your report, even if you comply with the state’s notification rule. Include these elements in your notification:

  • your name and contact information
  • the time, date, and place of the injury
  • the type and extent of the injury
  • the name of the supervisor in charge when you were injured

As soon as you have notified your employer, or even before you do, contact a workers’ compensation attorney to help you decide if the injury is severe enough for a workers’ comp claim. If it is, you’ll need an experienced workers’ compensation attorney to file the claim and manage the case for you.

Workers’ Compensation Doesn’t Cover All Injuries

Some injuries and illnesses won’t be covered just because you’re at work when they occur. If the injuries and illnesses didn’t happen on the job, they’re probably not covered. If the injury is the result of fighting, goofing around, or practical jokes, workers’ compensation likely won’t cover it. An exception, in this case, might be that the fight was over a work-related issue or that a practical joke was encouraged by your employer or employer’s representative, and you felt pressured to comply.

If you leave your workplace to eat and you trip and fall on the way to the restaurant, those injuries will not be covered. If, however, your boss sent you out to pick up lunch for the office and you trip and fall, workers’ comp will probably cover the injuries.

The difference here is that in the latter situation, you are on the clock performing workplace duties at your employer’s request. Your workers’ compensation attorney will help you determine whether or not your errand qualifies in getting you compensation.

Injuries that happen during the commission of illegal activities in the workplace are covered only under specific circumstances. If the crime is yours—for example, you’re using your employer’s garage to sell stolen vehicle parts after-hours—workers’ comp does not cover your injuries.

However, if your employer authorized or even required you to commit the illegal act, workers’ comp might cover your injuries. If, for example, your job is to paint cars and you get injured while painting a stolen car assigned to you by your employer, your injuries will be covered, but only if you didn’t know you were participating in an illegal act. If you did know or should have known that it was illegal, then you risk losing coverage for your injuries.

Workers’ comp will not cover self-inflicted injuries, regardless of whether or not you deliberately inflicted them upon yourself.

Workers’ Compensation Covers Off-site Injuries

Workers’ comp also applies when you are on the job, but not physically in your workplace. If you’re running an errand for your boss picking up supplies, delivering paperwork, or any task that takes you off-site and you are injured, workers’ comp will cover those injuries. As long as you are working (i.e., doing anything that furthers your employer’s business interests), workers’ comp will cover injuries and illnesses incurred.

If you work remotely, workers’ comp will cover injuries or illnesses caused while you are working, even if you are working at home. A workers’ compensation attorney will help you determine if you should pursue a workers’ compensation case and guide you through the process.

If you’re on a business trip, workers’ comp will cover most injuries and illnesses that happen while you’re on the trip, even if they happen while you’re not on the clock. In situations like this, you would not have been in a position to incur that injury if not for the fact that you were on the business trip.

Workers’ compensation will likely cover injuries that happen while traveling to alternative workplace locations, such as an off-site conference or training activity. If you are off-site for a work-related event, workers’ compensation will cover your injuries.

Commuting does not count as traveling for work, though, so you will most likely not be covered if you are injured or become ill while commuting to and from work.

Workers’ Compensation and Pre-existing Conditions

If you have a pre-existing condition, and it becomes aggravated or gets triggered by a workplace occurrence, contact a workers’ compensation attorney for help. However, be aware that workers’ comp cases that involve pre-existing conditions are more complicated than new injuries.

If you suffer an asthma attack while clearing out a dusty storeroom or a ruptured disc recurs because you lift a heavy box, workers’ comp may cover you. The pre-existing condition does not have to be from a previous workplace injury to be covered when it returns.

There are exceptions in these cases. If your doctor has told you not to lift heavy items while recovering from a previous workers’ compensation injury and you disobeyed their orders, you put yourself at risk for being denied coverage. Similarly, if your employer assigns you to shift boxes, and you did without telling them about the prohibition, you failed to prevent the injury and put yourself intentionally in a situation that may cost you coverage.

If you find yourself in the position of having to refuse to do certain work activities because of doctor’s orders, be sure to ask your workers’ compensation attorney for advice on how to handle your pre-existing condition situation. You could lose all of your workers’ comp going forward if you ignore your doctor’s advice and aggravate your existing injury or illness.

Workplace Injuries While Off the Clock

If you are on your way home, but still at your workplace, workers’ comp may cover your injury. If you trip in the employee parking lot on the way to your car, you will probably be covered because you’re still at work.

On the other hand, if you have left the company’s site, you will likely be deemed to have begun your commute, which is not covered by workers’ comp, as it occurs off the premises.

Injuries Incurred at Company-Sponsored Social Events

Workers’ compensation may cover injuries at recreational events, for example, if you were required to attend the event or if it was on company premises. If you are injured at an event that includes clients, even if it’s a social event, this falls under the umbrella of workers’ comp.

If, on the other hand, you trip and fall at a company holiday party where attendance was voluntary, and there is no business purpose for the event, the injury may not be considered work-related. Contact Bell & Pollock P.C., your workers’ compensation attorney, for help in determining whether or not you have a workers’ compensation case.

Intoxication Could Affect Your Workers’ Compensation Claim

If you are intoxicated (under the influence of drugs or alcohol) while working and you are injured, certain factors must be assessed to determine whether or not workers’ compensation covers your injury. If an intoxicated person causes an accident and you were injured, your injuries should be covered, while any injuries the intoxicated person incurs probably won’t be.

If you are intoxicated, but the accident was caused by someone else, your intoxication may not count against you in a workers’ comp case. In this situation, contact your workers’ compensation attorney for help.

Illness in the Workplace

Illness caused by your work situation can be more complicated than an injury like a broken leg. If your colleague has a cold and you catch it, you don’t qualify for workers’ comp, as there is no way to prove you caught a cold from one specific person. You may have gotten it at the store or from a family member at the height of cold season.

Workers’ comp applies if you can prove your workplace directly caused your illness. If you are exposed to dangerous elements or chemicals, such as asbestos, toxic mold, or lead, and become sick as a result, that is grounds for a workers’ comp case, since you probably don’t have those factors in other areas of your life.

Mental Health Problems Caused by Work

Mental health issues can be difficult to associate with work and are therefore harder to prove as workers’ compensation cases. Workers’ compensation cases involving pre-existing mental health conditions that are triggered or aggravated while working are even more difficult to navigate than pre-existing physical conditions.

In mental health workers’ compensation cases, you need an experienced workers’ compensation attorney. Contact Bell & Pollock P.C. to navigate your workers’ compensation case, and find out how we can help you.

Contact Us

Call a trusted attorney at Bell & Pollock, P.C. at (303) 795-5900 to get on the road to recovery now. You can also email our firm via the contact firm on this page.

As proud champions of the people, our lawyers are ready to answer your questions, explain the law and your rights, and help you take whatever steps necessary to recover the compensation you’re entitled to. With us in your corner, you can be confident that you have the legal support and representation necessary to successfully resolve your claim.

Don’t delay your recovery for a second longer – and don’t be misguided into thinking that you have to go through the process alone. Our attorneys are here, ready to help – and you won’t have to pay us anything until (or unless) there is a recovery in your case.

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Case Results

WE KNOW HOW TO WIN

CASE: Client was injured by a drunk driver. As a result of the motor vehicle accident, client was rendered a quadriplegic and needed a life care plan.
Outcome: $9,600,000

CASE: Against Insurance company for failure to pay for property damage after a gas and fire explosion.
Outcome: $1,600,000

CASE: Medical malpractice for failure to diagnose a descending aorta aneurism, resulting in death.
Outcome: $1,300,000

CASE: Neck and back injuries from car accident. Client had ongoing symptoms and needed injections for attempted remediation of pain.
Settled for $485,000

CASE: Client was injured in a 2 vehicle collision. She suffered a traumatic brain injury, concussion and multiple injuries to the neck.
Outcome: $6,000,000

CASE: Client was in her car and was T-Boned by a commercial vehicle. Her cerebral spinal fluid leaked and she suffered a concussion and traumatic brain injury with neck and lumbar (low back) injuries. Her neck injury caused radiating pain, numbness and tingling in her arms.
Outcome: $3,400,000

CASE: Client was driving on a rural road when another car crossed the center line and caused a head-on collision in the snow and ice. Client did physical work for a living. Both knees were injured, along with a neck injury.
Outcome: $2,300,000

CASE: Client was driving on South Parker road when another vehicle rapidly changed lanes and rear-ended the client. That vehicle was cited for careless driving. The collision caused a concussion with traumatic brain Injury. Client missed time from work and had a positive correlation between brain scan and neuropsychological test results.
Outcome: $950,000

CASE: Client was rear ended by a dump truck, was then knocked forward and hit another vehicle. Client had a concussion with traumatic brain injury. Client underwent a brain scan which showed hypoperfusion, correlated with her concussion symptoms. Client suffered neck injuries and injuries to her low back.
Outcome: $650,000

CASE: Client was rear-ended. The mechanism of injury from the forces in the collision caused her neck injury and at the same time, damaged her organs inside her throat. Client had swallowing and choking issues.
Outcome: $1,250,000

CASE: Client was in a motor vehicle accident. Both injections in the neck rendered some temporary relief. The Injections were transforaminal epidural steroid injections. Surgery was recommended on the lumbar (low back). The low back was injured by the forces in the collisions.
Outcome: $933,000

CASE: The client was driving in her car and was rear-ended thereby causing injuries to her lower back and neck. Client also suffered a concussion. Client had to undergo facet injections multiple times, through multiple procedures. Client also had cognitive issues which required cognitive training and therapy.
Outcome: $400,000

CASE: Client was entering a highway from an on ramp and was rear-ended by a commercial van. Client tested positive for Thoracic Outlet Syndrome and failed conservative treatment. Client underwent thoracic outlet syndrome surgey, which involved removal of the first rib to attempt to relieve pressure in the thoracic outlet. Client also suffered a back injury.
Outcome: $750,000

CASE: Client was injured by a drunk driver, who crossed the center line of the road. Client underwent multiple surgeries and could not work. Client was late 40s and needed a modified life care plan.
Outcome: $750,000

CASE: Client was rear ended by a tow truck driver who was a diabetic. The diabetic at fault party was a non-compliant diabetic and claimed he had a syncope episode, and was “blacked out”. Client had a preexisting back condition known and the forces from the collision aggravated, or made worse, the preexisting back condition in addition to, causing neck injuries.
Outcome: $350,000

CASE: Client was a passenger in a car where the driver fell asleep on a country road in the early morning hours. The car rolled multiple times. Client had eye injuries, facial injuries and neck and knee injuries.
Outcome: $850,000

CASE: Client was on the job, driving her own car, when she was rear-ended. She suffered a concussion with traumatic brain injury and pursued Workers Compensation Claim.
Outcome: $150,000

CASE: Client slipped and fell on snow and ice in Central City. He suffered back injuries, that did not require injections.
Outcome: $125,000

CASE: Client slipped and fell on snow and ice on a sidewalk in front of a business. She had to have knee surgery and multiple injections in her back.
Outcome: $175,000

CASE: Client was visiting a friend who was renting a house. Client tripped on untreated, dangerous section of deck and injured his back.
Outcome: $150,000

CASE:Client was rear ended and needed fusion spinal surgery. Insurance proceeds were limited.
Outcome: $125,000

CASE:Client was rear-ended and had to have rotator cuff surgery. Insurance proceeds were limited.
Settled for $65,000

CASE:Client was at Denver International Aiport traveling through Denver, slipped and fell and broke her ankle.
Settled for $118,750

CASE:Client was exposed to mold in a multi-family dwelling that was caused by leaking water.
Settled for $125,000

CASE:Motorcycle accident, reconstructive surgery, post-traumatic stress disorder, neurological injuries
Settled for $1,275,000

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