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Are All Workplace Accidents Covered By Workers’ Compensation?

ALL INJURIESOften, people assume that an injury sustained in or around the workplace is automatically covered by Workers’ Compensation Insurance though that is not always the case. There are a few common factual scenarios that specifically do not qualify for Workers’ Compensation benefits. In order for an injury to be compensable, it must occur within the scope of the employment, and not just during work hours. Here are a few examples of injuries that may not qualify for Workers’ Compensation benefits.

Lack of Causation

Sometimes injuries on the job are not actually caused by the work itself. For example, a worker with preexisting heart disease has a heart attack on the job. Upon examination, it is determined that the heart attack was caused by the preexisting medical condition, and not the work itself. This is a classic example of an injury that lacks a causal connection to the work, and is thus not covered under workers’ compensation.

Deviation From Employment

This scenario describes activities that would be considered unreasonable during the course of work, or a deviation from the job requirements. It applies in situations where a person acts in an unreasonable manner, such as jumping from heights instead of using the stairs or a ladder. If a worker is injured during these activities and it can be argued that no reasonable person would undertake those activities they are not compensable.

Some cases where deviation from employment was applied include:

  • Money v. Coin Depot Corp., 299 N.J. Super. 434 (App. Div.) – Where an armored truck driver began playing Russian roulette while he and his coworkers were driving their route. The gun discharged and the petitioner was killed. The court ruled that the activities that took place were so far removed from typical work duties and that no reasonable person would engage in them.
  • Jump v. City of Ventnor, 351 N.J. Super. 44 (App. Div. 2002) – Here the worker was injured while driving their work vehicle. He had stopped to pick up his own mail and fell and injured himself in the parking lot. Even though he had permission to do so from his employer his claim was denied due to the injury being sustained outside of his work duties.

Intentional Injury

Self-inflicted injuries are almost always denied by workers’ compensation. If an employee is angry and kicks something and that incident causes injury, it is not considered compensable.

Recreational Injuries

Employees injured during recreational activities, even while at work, are unlikely to see compensation. If, for example, a person decides to do a yoga session next to their desk during lunch and they sustain a back injury as a result, that claim is likely to be denied. Although they were at work when the injury occurred, the activity itself was recreational and not part of their regular job duties.

There are some instances where injuries result from “horseplay” between employees. If one employee playfully bumps another and he or she falls down and sustains an injury that will likely be treated as a valid claim since he or she is the victim of said horseplay.

Getting Help

There are many other considerations that must be accounted for when reviewing a potential claim. If you’ve been injured in a work-related accident, contact a workers’ compensation attorney to discuss the specifics of your injury and learn more about filing a claim.