While most work injuries are covered by workers’ compensation, there are a handful of exceptions. Importantly, workers’ compensation is a no-fault system. It does not matter if you or your employer’s carelessness caused the injury. In general, all that matters is that your injury arose from your employment. However, there are a few specific situations where workers’ compensation does not cover a wound.
Workers’ compensation insurance protects businesses and workers by providing benefits to most employees who get injured on the job. These benefits can address medical care and lost wages until the employee can return to work. In addition, the compensation is payable to dependents if a worker dies in the course of employment.
What Is Not Covered in Workers’ Compensation?
Workers’ compensation covers injuries and illnesses within the “course and scope” of your employment. Most courts have interpreted this phrase broadly and erred on the side of covering injuries to the benefit of employees. In general, if you are injured at your workplace while performing work duties, you will receive workers’ compensation. For example, a dishwasher who slips and falls while working in a restaurant kitchen is covered under workers’ compensation.
The workers’ compensation insurance is state-mandated, meaning that every state has its own workers’ compensation laws and programs. Workers’ compensation insurance also covers most incidents that occur while performing a duty outside the workplace with the employer’s express permission. Ultimately workplace incidents that involve employee injuries have to be determined on a case by case basis. However, there are situations where the insured employee claims would not be covered.
Commuting to/From Work
If an employee is injured on their commute to or from work, this is not considered within the course and scope of their employment and would therefore not be covered unless the employee has permission. So, for example, if a car hits you on your regular commute to the office, your injury will not be covered by Florida workers’ compensation.
On the other hand, your injuries will probably be covered if you drive a company car, if you don’t have a fixed work site or if you were running a work errand. For example, a salesperson may receive workers’ compensation benefits if they were injured while driving from home to the first client meeting of the day.
If an employee is under the influence of an illegal substance and the intoxication is the sole cause of their injury. The injury is generally not covered. For example, if you fall from a ladder because you were drunk, 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.
Horseplay at the workplace generally does not further the course of business, so a resulting injury will not be covered. However, there is an exception to that rule. For example, if an employee gets harmed during the incident but isn’t directly involved in the horseplay, they will benefit from work comp.
When a worker intentionally causes their workplace injuries or illnesses, they are not covered under the worker’s compensation insurance policy.
Most workplaces offer team building and recreational opportunities for their workers. Depending on the circumstances, injuries at social events – such as company picnics, holiday parties, or happy hour – might not be covered by workers’ compensation. Certain factors make it more likely that the injury will be covered. They include:
- The employee was required to attend the event or reasonably believed that the event was required
- The worker benefited from the worker’s attendance
- The activity occurred on the employer’s premises during business hours
However, if an event is voluntary and for the employer’s benefit only, the injury will usually not be covered by worker’s compensation. Whether or not a claim is covered by worker’s compensation is a fact-specific inquiry. Therefore, do not assume that your injury is not covered by workers’ compensation just because it happened at a social event.
Employee injuries from illegal activities at worksites are not covered by an organization’s workers’ comp insurance policy.
Workers who have been laid off or terminated from a job will no longer be covered under the workers’ compensation insurance policy unless the injury predates the employee termination.
Get Help From Miami Workers’ Compensation Lawyers
If you sustained injuries while working, you should get legal help immediately. That way, your employer would be unable to take advantage of you and give you the benefits you deserve. Contact us today at Miami Lawyers 360 for a free consultation.