• November 23, 2022

What is Not Covered by Workers Compensation Insurance

Workers’ compensation insurance is an important part of your business. It protects your company from liability claims, including medical costs and work-related injuries. But not all claims are approved. There are some things that aren’t covered by workers compensation insurance. Whether you’re an employer or an employee, you need to know what workers compensation covers and what it does not. Here are some instances not covered by workers compensation insurance.

Injury Sustained Due to Intoxication or Drunkenness 

If an employee injures himself or herself while intoxicated, there is no coverage under workers’ compensation. In other words: if an employee gets drunk at their desk during working hours and falls off his ladder while attempting to climb up it, they will not be covered by workers compensation insurance because this is considered “not an occupational disease.” A similar situation would apply if someone got drunk before going on duty; this also means no workers compensation coverage for injuries sustained due to intoxication in any form whatsoever.

Self-inflicted Injury

If the injury was intentionally self-inflicted, there is no coverage. Examples of intentionally self-inflicted injuries include:

• A person who cuts themselves with a razor blade and then claims he or she was injured by the cut because it wasn’t a safe way to injure oneself.
• A person who intentionally injures themselves by jumping off a bridge into water below, claiming that they did not intend to harm themselves.

Injury Sustained Due to Employee’s Willful Disobedience of Any Reasonable Rule of the Employer

No compensation is payable if the injury results from the employee’s willful disobedience of any reasonable rule of the employer.

• The employee must have been told of the rule and given a chance to correct it.
• The rule must be communicated to all employees in writing, or orally (if it was not previously communicated).
• The consistency with which this policy has been enforced overtime should also be considered when determining whether or not an injury was due to willful disobedience.

Injury Incurred While Traveling to or From Work

If you were injured while traveling to or from work, there is no coverage. If the injury was sustained while driving on the way to work because of another driver’s negligence, no one would be liable for paying any medical expenses related to that trip—even though it took place during working hours!

In this type of situation, workers’ compensation insurance can help cover costs associated with injuries accrued during travel (such as plane tickets). However, since these kinds of incidents don’t happen very often in real-life situations, it may not make sense just yet until after all other options have been exhausted.

Other Injuries Not Covered by Workers Compensation

There are a lot of injuries that workers compensation can cover. However, there are also a lot of instances wherein workers compensation will not be covered. As mentioned above, these are only a few instances in which you cannot claim for workers compensation insurance. It’s important to know what is and what is not covered. Here are some more examples of instanced not covered by the insurance : 

• An incident that arose out of an act of God
• Common, one-time illnesses such as influenza or headaches
• Condition(s) that existed before an employee was hired or began performing a particular job
• Contracting ordinary disease of life
• Employee’s horseplay that produces or causes an injury
• Employees who suffer a heart attack
• Injuries caused by a worker who starts a fight
• Injuries from repetitious mental trauma
• Injuries suffered during participation in an off-duty recreational activity
• Injuries suffered when an employee’s conduct violates company policy
• Injuries suffered while a worker was committing a serious crime
• Injuries suffered while an employee is intoxicated or using illegal drugs
• Injuries suffered while an employee was not on the job
• Injuries that can be treated with basic first aid, such as cuts or scrapes
• Willful attempt to injure oneself or another

Workers compensation insurance is a valuable tool for businesses and individuals, but it does have limits. There are many reasons why your company might want to consider adding workers compensation coverage, such as when employees are injured on the job in an accident or while performing their duties. However, it’s important that you understand how the protection works and what types of injuries aren’t covered by workers compensation insurance at all.

About Author

Naz Kleiman is a ANCC board-certified Nurse Practitioner with over 13 years of nursing experience in trauma nursing, primary care, women’s health, urgent care, workmen’s comp, allergy testing and family medicine. She graduated from the University of Texas with a Bachelor of Science in Nursing and Walden University with Master of Science in Nursing.