9 Employee Injuries Not Covered by Workers' Compensation Insurance & Why

Andrew Moran - Writer for TBR
By Andrew Moran
Nevena Radulović - Trusted Brand Reviews Editor
Edited by Nevena Radulović

Published November 20, 2022.

A man with an injured bandaged hand completing a work injury claim form

In 2021, employers reported approximately 2.6 million workplace injuries and illness cases, according to the Bureau of Labor Statistics (BLS) data. While this is down from 1.8 percent in the previous year, it's still a hefty number, one that might fail to improve workplace culture and result in lower productivity.

When companies manage workers' compensation, they'll assess how it happened and determine if the injury is covered by workers' compensation insurance. But what injuries aren't covered by workers' compensation?

Here are nine employee injuries that aren't covered by workers' compensation and the reasons why.

» Need help managing workers' compensation? Here's how to do it like a pro with Gusto

1. Acts of God

Surprisingly, acts of God are a common type of workplace injury. An act of God typically means that a natural act is out of human control, such as hurricanes, lightning storms, trees felled by strong winds, heavy rainfall, and a wide array of other natural disasters. So, for example, if you slip on a floor wet from a flood, that's an act of God workplace injury. However, this isn't covered by workers' compensation because the employer won't be at fault for something out of their control.

2. Injuries Resulting From Horseplay

Horseplay includes any monkey business at the office or shenanigans between co-workers in the workplace. But if you get injured while fooling around with your colleagues, are you entitled to workers' compensation? Generally, if the employee was the instigator of the boisterous actions, they won't be eligible for compensation. However, if somebody else caused the horseplay, there's a decent chance the employee could apply for workers' compensation.

3. Pre-Existing Conditions

Let's say you suffered from a significant back injury before you were employed. One day, as you were completing a heavy task at the office, you aggravated your back and triggered your pre-existing condition. Does this mean you'd be eligible for workers' compensation? While this can be a challenging process that will vary between states, workers' compensation generally applies only to injuries you obtained in relation to your position.

4. Willful Injury

A willful injury occurs when someone performs an unjustified act intended to injure another person. Although this might seem like a cause for workers' compensation, an accident must transpire while the claimant is at work and the injury must be related to work to qualify as such. Otherwise, workers' comp benefits won't apply to the injured person.

5. Injuries Related to Alcohol or Illegal Substances

Someone who consumes alcohol, smokes marijuana, or imbibes any other illegal substances and is injured on the job won't be eligible for workers' compensation. In this case, the employer won't be at fault because the employee got injured based on their worst judgment.

6. Injuries That Result From Company Policy Violations

Employees who violate company policies, rules, and procedures and get wounded as a result won't receive workers' compensation. Since the worker was the one who didn't adhere to the business' requirements for employee safety, the employer isn't at fault.

7. Injuries That Result From Illegal Activities

A workplace injury caused by illegal activities the employee participated in won't lead to workers' compensation benefits. If the illicit actions led to muscular hand injury or a steep fall, you'll be immediately disqualified from workers' comp.

8. Heart Attacks

Does a heart attack while working at the office automatically extend you the right to workers' compensation benefits? In many cases, claims for a heart attack or other cardiac issues will be concluded as having been triggered by a pre-existing condition, typically arteriosclerotic heart disease. However, it's still possible to be approved if the claimant can prove the heart attack was work-related.

9. Injuries That Occur Off-Site

With injuries that happen when employees are working off-site, it can be hard to determine workers' compensation eligibility, as it will be hard to figure out if the injury was work-related. Unless the claimant can prove the employment caused the injury, they'll usually be denied workers' comp benefits.

How Does Workers' Compensation Insurance Define a Covered Injury?

According to the Department of Labor, a covered injury is defined as bodily harm caused by an accident at work, and workers' comp will reduce liabilities for work-related injuries or illnesses.

Indeed, there are many instances where injuries will be approved for workers' compensation benefits. In fact, the most commonly approved claims will consist of lacerations, eye injuries, fractures, burns, and contusions. Most injuries that occur on the job will be covered by workers' insurance.

» Are you properly compensating your employees? See the difference between employee compensation vs. benefits

Conclusion

For the most part, work-related injuries or illnesses can be avoided entirely by having all parties involved follow the rules and regulations laid out by either the company or a third party, such as an industry group or the government. Businesses need to manage their workforce to ensure the best safety practices are installed, particularly for dangerous jobs. Unfortunately, accidents do happen, so it's important to determine if workers' compensation benefits will cover these injuries.

» For help managing workers' compensation, read TBR's payroll software reviews and find one that will get the job done.

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