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What Is Not Covered Under Workers’ Comp

Workers’ compensation insurance covers a wide range of injuries and illnesses, but it’s also important for employees to understand what is not covered under workers’ comp.

Designed to provide prompt benefits for employees who are injured on the job while eliminating the need to file a costly and time-consuming lawsuit, workers’ comp benefits are paid regardless of who is responsible for an employee’s injuries or illness. But claims are not paid under certain circumstances, including:

  • If a worker is hurt while under the influence of alcohol or drugs, committing a crime, or performing an activity specifically restricted by company policy. Denial of benefits is also likely if the injury is self-inflicted.
  • For common, one-time illnesses such as influenza or headaches.
  • For a condition that existed before an employee was hired or began performing a particular job. A pre-existing condition suffered by a worker that worsens due to conditions in the workplace may be covered under workers’ comp.
  • Injuries or illnesses that did not occur in the workplace or during the course of performing the job. An employee who is hurt while performing job duties away from the office may qualify for benefits. But an employee who is injured in an automobile collision while commuting to or from a job, for example, is not typically covered.
  • Injuries that can be treated with basic first aid, such as cuts or scrapes.

Workers Comp Coverage Is Not Always Clearly Defined

Conditions that develop over time, such as repetitive motion injuries, respiratory illnesses or even mental health issues, if they are found to be rooted in the workplace, can be the basis for a workers compensation claim.

In such cases, employees find hiring a workers’ compensation attorney to be helpful. An attorney familiar with the law and similar cases, canwork with a physician to evaluate your condition and obtain at least some portion of benefits.