What Injuries Aren’t Covered by Workers’ Compensation?

To file a claim for workers’ compensation benefits, an injury or accident must arise during the course of employment with the insured employer. Injuries eligible for compensation can result from an accident while performing one’s job duties, prolonged exposure to harmful work conditions, or injuries that result from repetitive physical strain like hearing loss or carpal tunnel syndrome. Many work-related injuries that occur as a result of work duties or during work hours are compensable, including those sustained while working from home. However, some incidents are not covered by the Workers’ Compensation Law.

What Does Workers Compensation Not Cover?

1. Injuries sustained as a result of criminal activity.
2. Injuries sustained at work while under the influence of alcohol or drugs.
3. Injuries or accidents arising out of an intentional act are not covered. If an individual is injured while engaged in a physical altercation with a coworker that is of a personal nature and not related to the employment itself, the incident is not considered work-related.
4. Cases that involve carelessness or negligence on the job.
5. Activties that occur on the job but are not considered job duties. For example, “horseplay” between coworkers during work hours is not considered work-related.
6. Detours in employment or those occurring while commuting to work are often not compensable. For instance, injuries occurring while on a lunch break or traveling to or leaving work will often not be considered work-related.

Every Case is Different

Every case is different and should be evaluated on its own merits. So it is important to review your case with an attorney before deciding to file a workers’ compensation claim. Exceptions to these examples do exist and cases are often decided on a few factors. Examples of important facts to be considered are whether the employer derives some benefit from the “detour,” or deviation in the typical workday, or if the injury occurred “in close proximity” to the employer’s premises. These are only some of the factors that will be considered when determining if the injury or accident arises from and during the course of employment.

The attorneys at Lewis & Lewis would be happy to review your case and answer any questions you may have. We can help you determine if your injury occurred as a result of your employment.