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What Injuries Are Not Covered By Workers’ Compensation?

A stamp that says Denied - to represent injuries not covered by worker's compensation.

What is Workers’ Compensation?

The purpose of workers’ compensation is to allow workers who are injured while on the job to be compensated for their work-related injury or illness without needing to prove their employer was negligent. In turn, the employer may not allege the worker was negligent and responsible for his or her own injury.

Why Do Worker’s Comp Claims Get Denied?

The statute requires the injury to occur “in the course of employment.” Therein lies the controversy. Employers often try to deny workers’ comp claims by arguing the injury occurred outside the course of employment and is therefore not covered.

What Injuries are Not Covered by Workers’ Compensation?

The statute specifically says that an injury is not covered if it was caused by “the employee’s intoxication or by his reckless indifference to danger.” It’s up to the employer or the insurer have to prove that the injury was caused by the employee being intoxicated or that he or she acted with reckless indifference.

Even if your employer denies your claim on that basis, you may still challenge the denial depending on the specific circumstances of your injury. For example, even if you were intoxicated when a fork-lift hit you in the back, your intoxication likely had nothing to do with your injury and you should qualify for compensation.

What about Injuries “Outside the Course of Employment”?

Driving to and from work is not considered an activity during the course of employment, so injuries, like in car accidents, that occur during these times are not covered by workers’ compensation. An exception to this would be if, on your way to or from home, you are doing an errand for your boss. If you are doing something to benefit your employer, then you are acting within the course of your employment.

If you are eating lunch in the break room and are injured, you are probably covered since it is considered a benefit to the employer for employees to stay on site during breaks. On the other hand, if you go across the street to pick up some fast food and are injured, that’s likely not covered since this is not an act for the benefit of your employer. If you were also picking up food for your boss to eat for lunch, then, you may be or may not be covered.

Are Injuries at Work-Related Recreational Events Covered?

If you are injured while at an office social event, like if you slip and fall while dancing at an office cocktail party for instance, or you are hit by a speeding baseball while at an office picnic, whether you are covered by workers’ compensation depends on several factors. You may be covered if you can prove:

  • You were required to attend the event; or
  • Your employer benefited from your attendance.

If the event occurred on the office premises during business hours, you have a greater chance of recovery.

What Other Injuries are Not Covered by Workers’ Compensation?

A few types of injuries are not covered by workers’ compensation in most cases include:

  • “Horseplay” with another employee.
  • Self-inflicted injuries. This particularly includes suicide.
  • Injuries incurred due to the employee’s illegal act.

What Should You Do if Your Injury is Not Covered or Claim is Denied?

If your claim for compensation has been denied, and your injury is not covered, you need an experienced workers’ compensation attorney who can evaluate your claim and discuss with you the possibility of winning your case on appeal. At Georgelis, Larsen & Sabatino Injury Law Firm, P.C., PC, we have years of experience fighting for the rightful collection of workers’ compensation benefits for our clients. Contact us to arrange for a free consultation at 1-800-HURT-NOW.

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