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 then do so many employees find their claims for compensation are 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.
Injuries Excluded from Coverage by Law
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.” The burden is on the employer or the insurer 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.
Injuries Occurring “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, you will likely not be 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.
Injuries at Work-Related Recreational Events
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.
Other Injuries Not Covered by Workers’ Compensation
A few types of injuries that will, in most cases, not be covered by workers’ compensation include:
- “Horseplay” with another employee.
- Self-inflicted injuries. This particularly includes suicide.
- Injuries incurred due to the employee’s illegal act.
If your claim for compensation has been denied, 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 Injury Law Firm, 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.