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What Injuries Are Not Covered By Workers' Comp?

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.

The federal government does offer its own workers' compensation insurance for federal employees; however, every individual state has

its own workers' compensation insurance program. That said, make sure you check your own state's workers' compensation laws by referring to the U.S. Department of Labor's website.

Before getting into what is not covered by workers' comp insurance, it's important to remember that most injuries that are classified to be work-related do not only have to occur on the employer's premises. It can happen at a company attended trade show or conference, business travel, or working at a place of business no matter the location.

What Does Workers' Comp NOT Cover?

Workers' comp insurance covers most, but not all, on-the-job injuries as 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 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 From The Injury Or Illness

  • 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.

  • 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.

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