Injuries Not Covered by Worker's Compensation

Worker's compensation is designed to provide financial assistance to individuals who suffer work-related injuries. However, not all injuries are covered under this system. Here are some situations where an injury is not covered by worker's compensation:

Commuting to and From Work

Under the "coming and going rule", travel to and from your fixed work site is not considered within the scope of your employment. For instance, if you are hit by a car during your regular morning commute to the office, your injury will not be covered by worker's comp. However, your injuries will probably be covered by worker's comp if you drive a company car, if you don't have a fixed work site, or if you were running a work errand 1.

Recreational Activities

Injuries at a social event—such as a company picnic, holiday party, or happy hour—might not be covered by worker's comp unless certain conditions are met. These conditions include the employee being required to attend the event, the employer benefiting from the worker's attendance, or the activity occurring on the employer's premises during business hours 1.

Intoxication or Substance Abuse

Most state workers' comp laws specifically exclude injuries caused by the worker's own intoxication. For example, if you fall from a ladder because you've been drinking, your claim will probably be denied. However, if you have evidence that the accident was unavoidable or not your fault, you may still be eligible for benefits 1.

Workplace Horseplay and Fighting

Because horseplay and practical jokes are considered to fall outside of the scope of employment, related injuries are typically not covered by workers' compensation. Similarly, most injuries caused by workplace fights or altercations are not covered by workers' compensation. However, if the fight is over a work-related issue, you might still be eligible for benefits 1.

First Aid Treatment

If you're injured at work, and the contents of a first-aid kit completely remedy your injury, the injury is not severe enough to warrant a worker's compensation claim. Cuts, scrapes, small wounds, or even a single headache are insufficient 2.

Cumulative Events and Injuries

There are many conditions and diseases that can give rise to a worker's compensation claim besides one-time accidents and injuries. Conditions such as carpal tunnel syndrome or respiratory conditions from repeated chemical exposure are frequent workers' compensation claims. These conditions arise over time due to repeated events at work 2.

Mental Health Conditions

Just like physical injuries and illnesses, mental health conditions can qualify you for workers' compensation benefits. Most states cover both psychiatric injuries from singular events, such as post-traumatic stress disorder (PTSD), and conditions arising over time, such as depression and severe anxiety 2.

Remember, the specifics of worker's compensation laws vary by state, so it's always best to consult with a local professional or lawyer to understand your rights and obligations.

Injuries Going Unreported

One common reason why workers' compensation claims fail is because the injury goes unreported. To receive workers' compensation, you must report that the injury occurred. Each state has a time limit for how long the injured person has to document the accident. Failing to report the injury within this time frame means you won't receive coverage 2.

Self-Employed Individuals and Independent Contractors

Workers' compensation does not cover self-employed individuals and independent contractors. These individuals can purchase general liability insurance, but they generally do not participate in the workers' compensation system. The nature of your work activities is essential to determine your true employment status and whether you're an employee or an independent contractor 2.

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 2.

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 2.

Check With Professionals About Eligibility

While workers' compensation provides significant support for those who suffer work-related injuries, it's important to note that not all injuries are covered. Factors such as the location of the injury, the cause of the injury, and the timing of the injury can all influence whether an injury is covered under workers' compensation. As such, it's crucial to understand the specifics of your state's workers' compensation laws and seek advice from a professional if you're unsure about whether your injury is covered.