Workers’ compensation protects businesses and the workforce by providing benefits to most employees injured on the job. These benefits address medical care, retraining, and lost wages until an employee can return to work. And in some cases, benefits are also payable to dependents if a worker is killed on the job.
Workers’ compensation insurance is state-mandated, which means that every state has different laws and programs relating to benefits. In California, employers are required by law to have workers’ compensation, even if they have only one employee. We’ll explain what workers’ compensation doesn’t cover in this article.
Common exclusions from workers’ compensation
While every state has different workers’ compensation laws, there are several situations where injuries fall outside the “course and scope of employment” rule, which we’ll highlight below. If you find yourself in any of these scenarios, contact a workers’ comp lawyer to learn more about your eligibility for benefits.
1. Recreational activities
Many workplaces provide team building and recreational opportunities for employees to bond outside the workplace. Depending on the event, workers' comp may not cover your injuries at a social event, such as a company picnic, holiday party, or happy hour. However, some factors make it more likely that the injury will be covered, including:
- You were required to attend the event or believed attendance was required
- The employer benefited from your attendance
- The activity occurred at your place of work during business hours
If the event was voluntary and for your benefit only, the injury will likely not be covered under workers’ comp. However, it’s always worth speaking with a workers’ compensation lawyer to determine your benefits eligibility.
2. Commuting to and from work
If you are injured while commuting to work, the courts tend to apply the “coming and going rule.” Under this rule, travel to and from your fixed work site is not considered within the scope of your employment. However, your injuries may be covered by workers’ comp if you drive a company car, don’t have a fixed work site, or if you were running a work errand.
3. Substance abuse or intoxication
Most state workers’ compensation laws specifically exclude any injuries caused by someone’s intoxication. Suppose you fall from a ladder because you have been drinking; your claim will probably be denied. If you have evidence the accident was unavoidable, you may be eligible for benefits.
Some states assume that injuries are non-occupation if drug testing shows high levels of alcohol or drugs. But intoxication defenses can be complex for employers to prove. If your drug and alcohol test was significantly delayed through no fault of your own, it might not prove you were intoxicated at the time of the accident.
4. Workplace fighting
Most injuries resulting from workplace fights or altercations are not covered by workers’ comp. However, you may be approved for benefits if the fight was over a work-related issue. Again, it all comes down to the specific circumstances surrounding each case, which is why it’s important to speak with an experienced workers’ compensation lawyer.
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