When an employee is injured on the job, they should generally be covered under workers compensation insurance. This insurance is offered by an employer to cover full time and part time workers, but unfortunately, it doesn’t cover everything. There are some injuries and circumstances where an employee injury may not be covered under workers compensation.
When it comes to workers compensation, intent matters. Intentional injuries inflicted by an employee to themselves will not be covered under workers compensation. For example, if an employee is filmed intentionally slipping after moving a wet floor sign, they may be denied workers compensation.
On the other hand, some injuries that are intentionally inflicted by other parties may be covered. If an employee is a victim of an attack by a customer, they may be covered under workers compensation insurance. But if an employee starts a fight with a client or coworker and is injured, they will likely not be covered.
There are different rules for workers compensation when it comes to pre-existing conditions. Overall, most pre-existing conditions are not covered by workers compensation unless directly worsened by the work.
For example, say you have a disc in your back from an injury previous to your job. At work, you sprain your ankle moving heavy equipment. Since your ankle is not related to the disc in your back, any medical needs related to your back will not be covered. Instead, workers compensation may only cover your ankle.
On the other hand, say lifting heavy equipment disrupts the disc on your back, causing you to need another surgery. Since the work directly affected your pre-existing condition, you may be covered under workers compensation insurance.
Sudden Illness or Disease
The same rule for pre-existing conditions apply to illnesses and diseases. A sudden cancer diagnosis will likely not be covered under workers compensation as it does not relate to the job at hand. However, if you work with chemicals or in buildings with asbestos, any related illnesses you may suffer could be covered under your employer’s workers compensation insurance.
Injuries While Intoxicated
Lastly, workers compensation injuries will not typically be covered if they occur while the employee is goofing around or under the influence of drugs or alcohol. If an employee is intoxicated at work and is injured, their injuries may not be covered.
Be sure to speak with your employer about what is and isn’t covered under your workers compensation policy.