What Injuries Are or Are Not Covered Under Workers’ Comp?

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Workers' Comp doesn't cover everything.If you’ve been injured on the job, it can be a confusing time. With medical bills to pay and the threat of time off work, it can be scary not knowing how you’ll continue to provide for your family. Something many injured workers want to know is what kinds of injuries are covered by workers’ comp insurance and which ones are not. To find out more, keep reading.
Broad coverage
Though you may expect workers’ compensation insurance to come with a million loopholes, the reality is that most states insist that policies broadly cover injured workers for a range of workplace accidents. The default position is that if a worker is injured during the course of his or her employment, that injury will be covered.
What about when the worker is partially at fault?
The good news for workers is that the workers’ comp system is known as a no-fault system. This means it doesn’t matter whether a worker is found to be partially responsible for his or her injury. Carelessness on the part of the employee or employer does not prevent workers’ comp from kicking in.
What isn’t covered?
Though workers’ compensation insurance pays out in many cases, it does not pay in all. There are several categories of workplace injuries that are not covered, including injuries that occurred because an employee was either intoxicated or under the influence of illegal drugs. Additionally, injuries that are self-inflicted, that were caused by a person starting a fight, that were suffered while committing a crime or that occurred while an employee was violating company policy are also not typically covered.
What about injuries outside the workplace?
Though it may come as a surprise to some people, workers’ comp will cover injuries that occurred outside the walls of your workplace, so long as they occurred within the scope of your employment. This means if you are injured while carrying out the duties of your job, regardless of where that injury occurred, you can be covered by workers’ comp insurance. A good example of this is if you are involved in a car accident off-site while going to visit a client or deliver goods. Though the accident took place outside the workplace, your errand was within your scope of employment and thus should be covered.
What about injuries outside the scope of employment?
You may be wondering whether injuries that occurred both outside the workplace and outside the scope of your employment, such as at home over the weekend or out driving on your own time, are covered. Unfortunately, as the name implies, workers’ comp only pays out when a worker has suffered injuries while at work. If you throw your back out doing chores at home, then you are on your own when it comes to taking time off work and paying medical bills.


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