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What Injuries are Not Covered by Workers' Comp?

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Workers' compensation insurance, often called "workers' comp," is a state-mandated program consisting of payments required by law to be made to an employee who is injured or disabled in connection with work. Workers' comp insurance premiums are paid by employers and not by employees.

The federal government offers its own workers' compensation insurance for federal employees; however, every individual state has its own workers' compensation insurance program. Check your own state's workers' compensation laws by referring to the U.S. Department of Labor's website.

Click here to view the Department Of Labor's website for your state's workers comp information.

Before discussing what is not covered by workers' comp insurance, it's important to remember that most injuries that are classified as work-related do not necessarily have to occur on the employer's premises. Work-related injuries can occur at a trade show or conference, during business travel, or working at a different place of business no matter the location.

What Injuries are NOT Covered by Workers' Comp?

Workers' comp insurance covers most, but not all, on-the-job injuries. However, it does not cover the following:

  • 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

What Types of Expenses Does Workers' Compensation Insurance Cover?

Although the payments are usually modest, workers' comp insurance covers:

  • Medical care resulting from the injury or illness
  • Rehabilitation expenses
  • Replacement income
  • Costs for retraining
  • Compensation for any permanent injuries
  • Benefits to survivors of workers who are killed on the job

Special Notes

If a person collects workers' compensation benefits, he or she cannot sue the employer in relation to the workplace injury. Workers' compensation benefits do NOT cover pain and suffering. Each individual state has its own set of workers' compensation laws. While most rules are similar, they may differ in each state depending on specific issues.

Questions?

For more information about this topic, contact Cindy McSwain using her information below.

Cindy McSwain

Senior Vice President
Outsourcing Services

Cindy McSwain leads AGH’s outsourcing services group. Her team provides payroll, accounting, funds disbursement, controller, and other financial outsourcing services to numerous clients throughout the U.S. Prior to directing the outsourcing group, Cindy served AGH’s audit clients for 10 years, working with a wide range of middle-market, closely held and family-owned clients.

Her current clients cross many industry sectors, including manufacturing, distribution, restaurants, retailers, medical, and not-for-profit. She has participated in numerous SEC filings and public registrations and has experience in mergers and acquisitions. Cindy is a certified public accountant and a member of both the American Institute of Certified Public Accountants and the Kansas Society of Certified Public Accountants.

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