When Are You & Aren’t Covered by Workers’ Comp

It is the employer’s responsibility to offer proper coverage for the financial losses suffered by their employees due to work-related injury or illness. Medical bills and lost wages are some of the main benefits of workers’ compensation. However, these may not apply in all circumstances.
One of the main conditions for the coverage to become active is for the ailment to be work-related. This does not necessarily need to happen in the office. Injuries that occurred while on a task or at a work party may also qualify. However, if the employee was disregarding company policy at the time of the incident, they may not benefit from insurance. Commute to and from work is also typically not covered, with a few exceptions. Read on to find out more.

Workers’ Compensation Covers

To access workers’ compensation benefits, you must prove that the injury or illness is work-related. This means that work conditions must have played a part in the accident. What is more, you must report it within 30 days to your employer. There is also a set deadline for submitting a claim. If you fail to meet these you risk not qualifying for benefits.

Work-Related Injury

Workers' compensation covers the vast majority of injuries that appear at the workplace. Several factors can lead to serious accidents, including faulty equipment, work activities, or exposure to dangerous materials.
Since the workers’ comp is a no-fault system, it doesn't matter who was responsible for the injury. Therefore, even if you are somehow to blame for causing the incident, you should still be covered (as long as it was not intentional).
What is more, the incident does not have to happen on company property, as long as it is related to work. For example, if you get injured while at a business meeting at a different location or during a company party, you might still receive benefits.

Work-Related Illness

Workers’ compensation covers both accidents and illness as long as it is related to work. However, the symptoms may take years to manifest. An employee might develop a condition following repeated and/or ongoing exposure to an inappropriate environment or harmful substances.
For certain conditions, it is relatively easy to prove that they qualify for compensation, since there is a lot of medical literature documenting the link with a specific activity or substance. Some of the most common work-related illnesses include:

  • Black lung disease from exposure to coal.
  • Asbestosis from asbestos exposure.

Besides, workers' compensation might offer some financial relief if you have contracted COVID-19 at the job or are quarantined and unable to work. However, eligibility is dictated by state law and the specifics of your case. Generally, it is essential to prove that you were exposed to the virus at the job. Also, the work environment must present an added risk compared to the general conditions to which the public is regularly exposed.

Workers’ Compensation Typically Doesn’t Cover

What a workers’ compensation will not include is determined by state law and varies between locations. Beyond the situations detailed below, your status with the employer also matters. If you are an independent contractor, you might not be eligible for claims.

Self-Inflicted Injuries

These are typically not covered by insurance, even if they have occurred during working hours. It should be noted that insurance companies can appeal to this detail as a way out of paying benefits.

Injuries Occurred While Commuting

Injuries due to accidents while commuting to and from work may or may not be covered by your insurance. However, some exceptions may apply. Driving a company car, traveling between different job-related locations, or special missions are just some situations that qualify as exceptions.

Injuries Occurred While Breaking Company Policies

Workers' comp does not cover work-related injuries that occurred while the victim was breaking company policies. The most common situations include being under the influence of alcohol or drugs at the time of the accident. Be sure to be very well familiarized with the specific policies that are in place at your company.

Willful Injuries Inflicted for Personal Reasons

According to Georgia state law, any injury willingly inflicted upon an employee for personal reasons may not be covered by insurance. Even if the incident has occurred in a work-related context, the motivation that led to it may not be considered relevant by the insurance provider.

Seek Legal Counsel

While workers’ compensation does cover most work-related injuries and illness, there are a few exceptions. If you have any uncertainties regarding specific laws in Georgia, contact a compensation lawyer in Atlanta. A qualified attorney can help guide you through the process of filing a claim. They can also make sure that you receive the benefits you deserve

Cheryl Roy has built a successful legal career over the years. However, she wanted to reach out to people beyond her practice and decided to do so by writing. Cheryl took it as a personal mission to make legal information more accessible to the public. Therefore, she started sharing her expertise with individuals and businesses facing a legal dilemma. Now she has branched out to many online and offline platforms and works as a collaborative editor for

Bader Scott Injury Lawyers.

 

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