The Limits of Workers Comp: What Isn’t Covered?

No responsible business owner should ever be without workers comp coverage. You are required to protect your employees against the financial losses that can come from a workplace injury, as well as to protect your business from the threat of lawsuits. Workers comp can be cut and dry in certain situations, but can extend to less clear-cut situations like repetitive strain injuries or psychological trauma. But what are the limits of these policies? Who and what does workers comp not cover?

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Protect your business from the threat of lawsuits with workers’ compensation coverage.

Are All Injuries at Work Covered?

Workers comp is probably one of the easier types of insurance policies to get a handle on. This type of coverage kicks in when an employee is injured on the job. It helps the employee with medical bills and lost wages, and it helps employers to avoid costly lawsuits. The general requirements for payouts are: 

  • A worker got hurt or sick while doing something for an employer’s benefit.
  • Work was the cause of the injury or illness.

It’s not always as simple as it seems, however. In some cases, employers might question whether they need to cover certain injuries. For example, what if an employee is injured at work but the accident was their fault? It may surprise you to know that workers comp is no-fault, so yes, even if a worker is injured because of their negligence, they are still eligible for workers comp. However, there are limits to this. If an injury is self-inflicted or if the employee was drunk or high, then their claim will be denied. 

Repetitive strain injuries (like carpal tunnel syndrome) and occupational illnesses (like asbestosis from working with asbestos) are also usually covered. However, things get a little less clear  when it comes to RSIs like chronic back pain or illnesses like heart disease or high blood pressure. There needs to be very strong evidence presented by an employee that their condition was caused by the work they do.

Does Location Matter?

Most injuries sustained while working are covered except for a few cases. But does an employee have to physically be at their place of business in order to be covered? No, in most cases it doesn’t matter where the employee is, they could even be traveling between locations. 

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But, let’s look at the case of a salesman in Mississippi who was injured in a car accident in the course of his working day. On the day of the accident, he made a sales call in the morning and then headed to his brother’s house (who worked for the same company) to deliver something for a project unrelated to their work. On the way, he had a car accident and later, a heart attack. He filed for workers comp, claiming that he was also planning on giving his brother a work-related document. His claim was denied, since it was ruled that he was not doing something for his employer’s benefit when the accident happened. The errand was considered personal, because he would not have gone to his brother’s house to drop off the document if he hadn’t also been going to make his other delivery. So, while the place where the accident happened does not matter, the rule of employer’s benefit always applies.

Are All Workers Covered?

Consider the following case: a physical therapist, working for a physician’s assistant at offsite locations, gets injured in a car crash on the way to an appointment with a patient. We have already seen that, as long as the employee is working or traveling somewhere to benefit their employer, offsite accidents should be covered. 

So this should be an open and shut case, right? In this Arkansas case, though, the problem is that the physical therapist was not considered an employee traveling for an employer. The physical therapist was actually determined to be an independent contractor. This type of worker is contracted to perform a service independently, not under the direction of the hiring company, and are usually paid per job as opposed to being salaried. They are not considered employees, and are not eligible for workers comp benefits.

Workers Comp Deadlines

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Depending on the state, employees need to tell their employer within 10-90 days of the accident.

Workers comp is generally pretty generous, and many cases favor the employee. Employees, however, cannot simply decide one day to file a claim for an injury that happened months or years ago. Depending on the state, employees need to tell their employer within 10-90 days of the accident happening in order to have a legitimate claim, and they need to file a complaint with their state within between 1 and 3 years. There are exceptions to these rules, but in most cases there are time limits to receive workers comp benefits.

Workers comp is a very valuable and necessary type of insurance for all business owner’s to have. It protects the workforce that you rely on and care about, and it protects all the hard work that you’ve put into building your business. But, like all insurance policies, it has its limits, and all employers and employees should be aware of what is covered and what is not. If you need any help with coverage for your business, EZ.Insure is here to help. We’ll get you instant quotes and set you up with your own dedicated agent – for free! You’ll get all of your questions answered and get the most accurate quotes. You have enough on your plate, so let us take care of your insurance needs. To get started simply enter your zip code in the bar above, or you can speak to an agent by calling 888-615-4893.

About The Author: Cassandra Love

With over a decade of helpful content experience Cassandra has dedicated her career to making sure people have access to relevant, easy to understand, and valuable information. After realizing a huge knowledge gap Cassandra spent years researching and working with health insurance companies to create accessible guides and articles to walk anyone through every aspect of the insurance process.
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