Type of Injuries Covered by Workers’ Compensation

The key idea behind workers’ compensation laws is that a non-exempt employer provides a benefit to cover all on-the-job injuries, regardless of their severity, without having to determine fault. The real limits of the law come not in the type of injury but in how the injury occurred.

Exclusions from workers’ compensation apply when an employee is injured while committing a crime if the injury is self-inflicted, if the injury occurs while the employee is under the influence of drugs or alcohol, or if the injury results from a specifically restricted activity. In these instances, an insurance provider cannot approve the claim.

A work-related injury need not occur on the employer’s premises. If an employee is at an off-site conference, traveling from one facility to another, or working at a place of business or home of the employer’s client, any injury that occurs will be considered a work-related injury. Any activity conducted in the employer’s name needs to be expressly excluded in advance if, for some reason, workers’ compensation benefits would not be extended in the case of an accident or occupationally related exposure.

Additionally, an employer may contractually add a covered benefit that might otherwise not be included under a particular state’s worker’s compensation laws. If an employee needs to conduct an activity completed on their own time, on the employer’s premises, and not directly work-related but to the employer’s benefit, a claim may be approved. However, such instances need to have a written agreement in place before the accident.

In some instances, an employee might experience an illness—rather than an accident—that results in injury. Exposure to a toxic substance, repetitive activity, or a traumatic incident that creates mental health issues could lead to an approved claim. Occasionally, the illness might not surface for many years but still be considered compensable. Commonly contracted illnesses such as influenza, sickness from mosquito bites, or a headache that the employee believes results from on-the-job contact are excluded from worker’s compensation law.

Each state has its own worker’s compensation laws. While they are all similar in content, they may differ from one another on specific issues. It is wise to consult individual state laws to determine if a particular injury or occupationally related illness, or the circumstances behind the exposure, are compensable under those laws.

Workers’ compensation covers the vast majority of work injuries and diseases. Injuries not covered by workers’ compensation in many states are:

• Injuries occurring as a result of crime
• Injuries from violation of posted and known company policies
• Injuries from intoxication or drug use
• Off-work injuries
• Self-inflicted injuries
• Pre-existing conditions, unless exacerbated by current work

Some exceptions to employer immunity or situations that would usually allow injured employees to sue their employers outside of the workers’ compensation system are:

• Injuries caused by employers’ malice or recklessness
• Injuries caused by employers’ violations of state or federal law, such as violations of the Occupational Safety and Health Act (OSHA)
• Intentional injuries
• Injuries caused by employers when acting in dual capacities, such as breaches of legal duties as property owners, landlords, medical providers, or manufacturers of work equipment
• Injuries to employee property
• Bad faith administration of workers’ compensation claims
• Employers’ retaliation against employees for pursuing workers’ compensation claims, such as by firing or demotion
• Nonphysical injuries such as defamation or discrimination