What Workers’ Compensation Won’t Cover

Workers’ compensation is an essential component of the social welfare system in California.  With workers’ compensation, an employee can receive medical expenses to treat the work-related injury, replacement for lost wages, and permanent benefits if the disability is permanent.  Workers’ compensation benefits can also help to provide training for a new career if the injured employee is permanently disabled and unable to return to work in the capacity he or she previously worked.  There are, however, some things that workers’ compensation will not cover.

One thing that workers’ compensation will not cover is if the employee has an injury that is self-inflicted.  For example, if an employee intentionally slices his arm on a piece of equipment, workers’ compensation would not cover that injury.  Employers should also be cautious of these injuries, as an employee trying to claim workers’ compensation benefits for an injury that was intentionally self-inflicted may also be committing insurance fraud.

Another way that an employee’s injuries may not be covered by workers’ compensation is when the injury was not incurred during the course and scope of the employee’s employment duties.  One of the most common examples of this type of injury is when an employee gets in a car accident during work hours, but he or she is not engaged in work-related activities. For example, if the employee is on a lunch break or running a personal errand, that would not be in the course and scope of employment, and therefore any injury sustained during an accident would not be covered.

Third, some pre-existing injuries will not merit a new workers’ compensation award.  Employers need to keep in mind that if a pre-existing injury is aggravated and worsens as a result of employment, then the employee may be able to recover under workers’ compensation. In other words, whether an employee can recover under workers’ compensation at your business as a result of disability and injury related to a pre-existing injury is a delicate and sometimes complicated inquiry.

Finally, if an employee is injured during an altercation at work that he or she started, then workers’ compensation may not cover those injuries. For example, if your employee assaults a customer, then any injuries sustained in the ensuing fight would not be covered.  However, if the employee is assaulted first by the customer, the injuries may be covered.

If you have questions about whether the circumstances in your case will qualify for workers’ compensation, call us today.  We can help you understand the workers’ compensation system and how your business fits within it.

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