Workers’ compensation benefits won’t cover the cost of medical treatment for injuries or accidents that occurred outside of work or for pain and suffering. State and federal laws and policies define work-related injuries.
Incidents that may not be covered by workers’ compensation include:
- Accidents or injuries that occur outside of the workplace or in non-work capacities
(Example: If a food worker accidentally cuts their hand while in their own kitchen)
- Accidents or injuries that occur while an employee is intoxicated
(Example: If an employee reports to work under the influence—and an injury happens—this worker may have forfeited their right to workers’ compensation)
- Accidents or injuries that are proven to have been caused by an intentional, risky, non-work activity at the workplace
(Examples: Horseplay, accidents or illnesses stemming from practical jokes)
Some accidents may appear connected to a worker’s position, but they may not be compensable if they were not sustained while performing job requirements. For example, workers’ compensation may not provide benefits if:
- The accident or injury didn’t occur at work
(Example: A worker is injured while driving to work, as the commute isn’t part of the job’s specific requirements, even though they drive for work once they’re on the job. If they’re driving a company car, the injury may be covered, depending upon the specific facts and the state jurisdiction.)
- The accident or injury occurred at the workplace, but not in the scope of work
(Example: An employee accidentally hurts their leg while in the office gym. Unless they’re hired as a fitness instructor, required to use the gym, or attending a mandatory event, this injury may not qualify for workers’ compensation, depending on specific facts and state jurisdiction.)
When in doubt, report
Regardless of whether you think an injury is covered by workers’ compensation, you should still report it and let the process sort it out. Generally, if it’s determined that a worker is injured while on the clock performing their job duty, workers’ compensation can likely provide benefits, from medical coverage to wage replacement or something else. Click here to review the benefits of workers’ compensation for employees.