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.