Did you know that not all injuries that happen at work are covered by workers’ compensation?
It’s generally true that workers injured during the course and scope of their employment are entitled to workers’ compensation benefits, such as medical care and medical costs, retraining expenses, lost wages, or compensation for permanently disabled workers or the dependents of those killed in the course of their employment.
However, even though workers’ compensation is a no-fault system, not every at-work injury is covered. Each accident is assessed on its own factual circumstances on a case-by-case basis.
Here’s a list of a few common workplace incidents that aren’t covered by workers’ compensation.
1. Injuries caused by intoxication or substance abuse
If the employee is under the influence of an illegal substance and intoxicated when they’re injured, the employee will generally not be eligible for workers’ compensation benefits. The intoxication, not the employer, will be viewed as the cause of the injury.
In North Carolina, if drug testing shows a high level of alcohol or drugs, then it will be assumed that the injury was not related to the employment.
2. Injuries that happen during recreational activities
Generally, if an injury occurs during a morale-boosting event for the employee’s benefit, like a company picnic or holiday party, then any injuries sustained there would not be covered by workers’ compensation.
However, an injury might be covered if the employer required attendance at the event, the event was held on the employer’s premises, or if the employer benefited from the worker’s attendance at the event (such as an off-site working lunch).
3. Intentional acts, such as horseplay or fighting
If an injury occurs in the workplace, but not in pursuit of the employer’s business, then the injury will not be covered by workers’ compensation. Innocent bystanders who aren’t involved in such antics may be covered for any injuries they sustain.
4. Injuries that happen while commuting to and from work
Generally, if an employee is hurt on their way to or from work, the injury would not be considered within the course of their employment. However, if the employee’s contract covers transportation to or from work (such as an on-the-road salesperson) or if the employee is on the premises (such as the employer’s parking lot), then they may qualify for workers’ compensation coverage.
5. Injuries that result from policy violations
If an employee is injured while doing something against company policies, procedures, or protocols, then workers’ compensation benefits will not be available.
But there are exceptions to the exceptions too
Even within these general exceptions to workers’ compensation, there is a possibility that an injured worker might still be entitled to benefits. As discussed, workers’ compensation depends on the specific facts and conditions surrounding the incident. For example, although a commuting employee is generally not entitled to workers’ compensation, if the worker was conducting a work-related phone call at the time of the accident, then there is a stronger argument that the activity was conducted in the course and scope of the employee’s job.
If you need help determining whether you might qualify for workers’ compensation benefits, contact the experienced workers’ compensation attorneys at Hunter & Everage in Richmond, Virginia, and Charlotte, North Carolina.
