When you're hurt on the job, you assume workers' compensation will cover your medical bills and other damages you suffer as result. Most of the time, you'd be right. However, there are some instances where it's not clear whether an injury will be covered or not. Here are three times when your eligibility for workers' comp coverage may land in the grey zone.
Travel for Work
One area where there is quite a bit of confusion about coverage is when employees are injured while traveling for work. It depends on what you are doing at the time the injury occurs. If you get into an accident on your way to work (i.e. during your commute), your injury will not be covered, even though you are commuting for your employer's benefit.
In general, workers' comp only covers you when you're on the clock or actively doing something connected to your job. For instance, if you're out making deliveries to customers and you get into an auto accident, that accident would be covered by workers' comp since you were working at the time.
The only time injuries during your commute may be covered by workers' compensation insurance is if you were traveling to another work site that's not where you normally go (e.g. a business trip). Additionally, if you don't have a set workplace and must travel from site to site (e.g. traveling salesperson), you would be covered during the times you were commuting to wherever your floating workstation was located.
Horseplay at Work
One of the things that so attractive about workers' compensation is the fact you will still get benefits for your injuries regardless of who's at fault for the accident. One exception to this rule, however, is willful misconduct. If you do something you know has a high likelihood of resulting in injury or fell outside the scope of your employment, your claim for damages may be denied.
The activity that many states hold up as an example of this is horseplay. You and a coworker are tossing around a basketball during work and the ball hits you in the face, causing you to fall over and sprain your wrist. Your claim may be denied because you were engaged in an activity that deviated significantly from your work duties, especially if the activity went against the company's safety protocols.
States typically look at a variety of factors when determining whether horseplay is covered or not. In South Dakota, for example, the court looks at the following four factors:
- How long the horseplay went on for and the seriousness of it
- Whether the employee abandoned work to engage in horseplay or if the activity occurred during a lull
- Whether the employer allowed employees to engage in horseplay or, at least, didn't stop the activity from occurring
- Whether horseplay was likely to occur due to the nature of the job
For instance, if a person worked in a toy store and was injured while playing with some of the toys, the employee's injuries may be covered even though he was engaged in horseplay, because the nature of the job made it more likely such conduct would occur.
Each state is different, though, so this is one area where you really have to research the specific laws in your state to determine how workers' compensation handles the issue.
Another gray area is company events. If you are injured at an event hosted by your company, it's not always a given that workers' comp will pay out benefits for it. The decision may come down to whether attendance was mandatory or not.
Your claim is more likely to be approved if you were required to be at the event, because you could make the case the activity fell within the realm of employment. This is particularly true if there are aspects of work integrated in the activity (e.g. you have schmooze customers during the company Christmas party).
On the other hand, you claim may be denied if the event was purely voluntary because the insurance company could make the case that you came of your own free will and the event was recreational in nature rather than work related.
For more information about this issue or help with your workers' comp claim, contact resources like Gilbert, Blaszcyk & Milburn LLP.