Law

These Four Incidents May Not Be Covered By Workers’ Compensation

Workers’ compensation is unlikely to cover injuries sustained when an employee: was under the influence of drugs or alcohol, was committing a crime, was away from his or her job or not doing his or her duties, or violated the company’s safety rules. However, there are exceptions where an employee could obtain workers’ compensation benefits despite being injured in one of those scenarios.

Here is a closer look at these four incidents typically not covered by workers’ compensation, along with the circumstances in which they could be covered.

Intoxication

Workers’ compensation laws usually exclude injuries resulting from an employee’s own intoxication. For instance, an employee who falls from a ladder because he or she has been drinking will be denied workers’ compensation benefits. A person driving from one work site to another and is under the influence will also generally not be entitled to receive benefits if he or she causes an accident.

In cases where a worker is under the influence of drugs or alcohol and is injured, it must be proven that the intoxication primarily caused the worker’s injury. Otherwise, the worker may still collect benefits if he or she can prove that the accident was not his or her fault or was unavoidable.

For example, an employee who was delivering a package while intoxicated and is hit by a vehicle as he or she walks through a crosswalk or along the street would be eligible for the benefits. The accident was not a result of him or her being intoxicated. Similarly, an employee under the influence and is struck by a lift truck from behind while working on the factory line could receive workers’ compensation.

In 2011, a park worker who had used marijuana was mauled by a bear. The court awarded him compensation because his drug use did not contribute to the attack.

Crime at the Workplace

Employee injuries caused by participation in unlawful activities at the worksite are usually not covered by an employer’s workers’ compensation insurance. For instance, an employee injured while using his or her employer’s premises to sell stolen items after hours would not be eligible for workers’ compensation benefits.

Illegal activities at the workplace may be covered in specific circumstances. For example, an employer may have authorized or required an employee to engage in the illegal act. A person who paints cars may have a stolen vehicle assigned to him or her by the employer. If he or she gets injured while painting the vehicle, the injuries would be covered if the employee did not know that he or she was engaging in unlawful activity.

Outside the Course and Scope of One’s Employment

Workers’ compensation only covers work-related injuries. For an injury to be work-related, it has to be sustained during the scope and course of one’s employment. If a person was not on the clock or was engaging in activities that were not benefiting the employer at the time of the injury, then the person’s workers’ compensation claim may be dismissed.

Workers’ compensation insurance policies typically exclude coverage for injuries suffered as an employee commutes to and from his or her workplace. Injuries sustained when taking a break or lunch outside the workplace are also not covered, even if one was on the clock.

Some injuries fall within the course and scope of a person’s employment, even if they occur outside the workplace. For example, most injuries and illnesses suffered when employees are off-duty during a business trip will be covered by workers’ compensation. That is because employees would not have been in the position that led to them incurring the injuries or illnesses were it not for the business trip.

A worker may also be eligible for benefits if he or she was sent out to pick up food for the office or a meeting and sustained an injury. The employee was performing a duty at the employer’s request. A work injury attorney can help one determine whether his or her errands qualify for workers’ compensation benefits.

Safety Violations

Employers have a right to set rules and guidelines to help promote employee safety. Workers are usually required to follow the regulations to help avoid workplace accidents and injuries. If a worker is aware of the policies but decides to act against them and gets injured, the injuries may not be covered. Moreover, a worker who deliberately violates a company’s safety rules may face significant consequences, such as heavy fines.

Nevertheless, an employee who violates a safety rule and is injured can still receive workers’ compensation benefits if the violation was not an intentional act.

Ultimately, incidents that cause employee injuries should be evaluated on a case-by-case basis. An employee should not assume that his or her injuries are not covered because he or she was injured in one of the four scenarios. A workers’ compensation lawyer can independently review an employee’s situation and determine the ideal way to move forward with the case.

Adrian

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