A work injury can raise a lot of questions. You want to know if your injury is going to be covered by workers’ compensation. While workers’ compensation covers many injuries, there are some notable exceptions that you need to be aware of. Workers’ compensation does not include some types of accidents. Our skilled workers’ compensations lawyers explain 10 things that are not covered by workers’ compensation.
What Is Not Covered by Workers’ Compensation?
What is not covered by workers’ compensation is any injury that occurs outside of the course and scope of employment. For workers’ compensation benefits to apply, the injury must occur during the injured victim’s work activities.
If the accident occurs outside of the person’s work duties, it’s not covered by workers’ compensation. Other kinds of injuries are not covered by workers’ compensation, including injuries caused during the commute to work and injuries caused by the employee’s own intoxication while on duty.
Injuries That Are Not Covered by Workers’ Compensation
Here are several types of injuries and circumstances that are not covered by workers’ compensation:
- Minor injuries – Some injuries require only first aid treatment. You may not need to see a doctor, and you may recover in a few days. Minor injuries that don’t require medical care aren’t covered by workers’ compensation.
- Intoxication – If an injury occurs because of the employee’s own voluntary intoxication, their losses aren’t covered by workers’ compensation. Alcohol or drug intoxication may mean that the victim can’t receive payment for their losses.
- Injuries that go unreported – To receive workers’ compensation, you must make a report that the injury occurred. Too many victims never receive coverage because their injuries go unreported. Each state has a time limit for how long the injured person has to document the accident.
- The drive to work – Accidents that happen on the commute to work aren’t covered by workers’ compensation. If you’re hurt while driving, walking, biking, or using public transportation to get to work, the workers’ compensation system doesn’t apply to your injuries. However, if your work duties include traveling, injuries that occur during travel for your employer is covered.
- Self-employed – Self-employed individuals can’t claim workers’ compensation. They can purchase general liability insurance. But generally, self-employed people don’t participate in the workers’ compensation system.
- Independent contractors – Like self-employed workers, independent contractors aren’t covered by workers’ compensation. However, the title that your employer gives you isn’t necessarily the answer to whether you’re an employee or an independent contractor. You can look deeper into the nature of your work activities to determine your true employment status and whether you’re an employee or an independent contractor.
- Recreational activities – Your employer may sponsor a happy hour or a company picnic. They might have a Christmas party. These activities don’t fall under workers’ compensation. Recreational activities aren’t part of the workers’ comp system.
- Injuries during lunch break – Injuries that happen during the lunch hour may or may not be covered by workers’ compensation. If you stay in the lunchroom, your accident may still be covered. However, if you travel off the property for your lunch break, your injuries may fall outside workers’ compensation.
- Fights – If you get into a fight at work, your injuries probably aren’t covered by workers’ compensation. It might depend on what the argument was about. A fight about your work duties may still be covered. However, if you fight about something completely unrelated to work, you can’t ask for workers’ compensation to cover your injuries and expenses.
- Income you’re still able to earn – You can recover workers’ compensation for the decrease in income that you have because of the accident. If you’re still able to earn some income, you receive only the difference in what you made before the accident and what you can make given your new limitations. You also recover compensation for your medical bills. However, you don’t recover workers’ compensation for the money that you’re still able to earn after an on-the-job accident.
In general, the test for whether or not workers’ compensation covers you is whether the accident occurs within the scope of your employment. You look at whether your accident is a predictable part of the job. Questions like whether you were doing your employer’s bidding and whether you were at work or traveling for work are critical to the inquiry. Each determination is fact-specific based on the rules for what’s covered. An experienced attorney for workers’ compensation can help you determine if your accident and injuries are covered.
Does Workers’ Compensation Cover Horseplay?
Yes, horseplay is usually covered by workers’ compensation. Horseplay is an accepted part of many jobs, and workers’ compensation may cover an injury that occurs during horseplay. However, if the injured party completely abandons their job duties during horseplay, the injury may not be covered by workers’ compensation. To make a determination, it’s important to look at how the injury occurs and consider whether the injury is outside of the predictable nature of the employment.
Who Is Not Covered Under Workers’ Compensation?
The workers’ compensation system does not cover self-employed individuals and independent contractors. In addition, employees whose employers don’t have to have workers’ compensation insurance aren’t covered by workers’ comp.
Some states require an employer to carry workers’ compensation insurance only if they have a certain number of employees. Other states require all employers to have insurance. Some people are not covered by workers’ compensation, including self-employed individuals, contractors, and people whose employers aren’t legally required to carry insurance.
Our Attorneys for Workers’ Compensation Coverage
The best way to know if workers’ compensation covers your claim is to speak with our experienced workers’ compensation attorneys. The legal team of Adam S. Kutner & Associates is experienced in helping clients receive the maximum amount of compensation that they deserve. We can help you evaluate whether your claim is covered by workers’ compensation. If it is, we fight tirelessly for you until you receive everything that you deserve.
Call us today. Your call is free and confidential. We look forward to talking to you.