What Types of Injuries Do Not Qualify for Workers’ Compensation?

Workers’ compensation protects you if you’re injured while doing your job. You’re entitled to seek benefits like wage replacement and medical coverage when you are hurt at work.

However, not every injury is eligible. What types of injuries do not qualify for workers’ compensation?

Let’s look at these injury types and some tips about what to do about a denied claim.

Injuries That Happen Outside of Work

Workers’ compensation covers certain types of injuries, but not all.

Your injury must happen while on the job or performing job-related tasks. If you get injured while doing something unrelated to work, such as running personal errands on lunch, then your claim is likely to be denied.

Self-Inflicted Injuries

Some people believe that no questions will be asked if you get hurt on the job. However, if you intentionally hurt yourself, workers’ comp will not cover the injury.

Workers’ compensation protects you from accidents, not intentional acts. Claims like these are denied if you suffered an injury that you caused to gain compensation.

Injuries Caused by Misconduct

Some workers engage in fun at the office, but injuries due to reckless behavior are not covered.

Your claim could be denied if you’re hurt because of misconduct or breaking workplace rules. On the other hand, if someone else’s misconduct injures you, you might still qualify for workers’ comp benefits.

Drug- or Alcohol-Fueled Injuries

If you are under the influence of drugs or alcohol when you get hurt at work, it could affect your workers’ compensation claim. Most states have laws stating that if your injury was caused by substance use, your claim may be denied.

In these cases, your employer will need to prove that substance use was a direct cause of the injury to deny the claim.

Many times, this can lead to issues with your claim. Even if you test positive for drugs or alcohol after an injury, you can still challenge the denial. You will need to prove that your impairment did not contribute to the accident.

Pre-Existing Conditions

If you have a medical condition that existed before you started your job, and you get injured due to it, your workers’ comp often will not cover it. However, if your job made the condition worse, you may still be eligible for benefits.

For example, if you have existing back pain, but it becomes more intense from lifting heavy items, then you might be able to file. You could qualify for compensation for the aggravation of that pre-existing condition.

Psychological Injuries Not Tied to Work

In some cases, workers’ comp can cover mental health injuries, such as anxiety or depression.

Once again, there needs to be a direct connection between the injury and your job. Claims for emotional distress or mental health conditions that are unrelated to work aren’t eligible for compensation.

Independent Contractors and Volunteers

Workers’ compensation will not cover you if you’re an independent contractor or a volunteer.

Why?

You’re not considered an employee. Independent contractors are self-employed. As a result, their injuries are their own responsibility.

However, there may be exceptions if an employer has specific contractor coverage. Depending on the state, volunteers can sometimes receive coverage under workers’ compensation laws.

Your Claim Is Denied, Now What?

If your claim is denied, you may have to take several steps to prove that the injuries did occur on the job. You have the right to appeal the decision and protect your rights. In some situations, you might even be able to get the case reopened.

First, you need to look at the denial letter. A denial may be due to a lack of evidence, missed deadlines, or disputes over whether the injury is work-related.

If you believe your injury does not fall into the above categories, you will need to gather more evidence to prove your claim. This can include additional medical records, witness statements, or other documentation supporting your claim.

In most cases, you will be granted a hearing. With the help of an attorney, you can build a case that shows your injury is related to job activities.

Remember, each state has its own laws, so consult with an attorney to understand your options and deadlines for appealing a denial. While workers’ compensation can help those injured at work, it doesn’t cover everything.

If you are unsure whether an injury qualifies for workers’ comp, you should speak with a workers’ compensation attorney. With that, you can clarify the specifics of your situation and make sure you understand your rights.

At Work Injury Advisor, we have the resources to help answer your questions.