When Your Injury Might Not Be Covered by Workers’ Comp

February 17, 2019

As a general rule, if you are injured on the job in New York, you will be eligible for workers’ compensation benefits. However, there are exceptions to the rule. Also, the definition of “on the job” can be a grey area that excludes certain injuries, to the surprise of the injured worker.

Injuries outside the scope of employment

As we mentioned in our last post about workers’ comp and personal injury lawsuits, injuries sustained during the commute to or from work do not fall under the protection of workers’ comp laws. This is because, despite the fact that employees must commute to perform their jobs, commuting is not considered to be within the scope of employment. Conversely, if your job requires you to drive from one work site to another during the work day, this likely will be considered within the scope of employment.

A similar issue arises when a worker gets hurt during a lunch break. Typically, an employee taking a lunch break is considered to be on personal business and not acting within the scope of their employment. Therefore, any injuries sustained will not be covered by workers’ comp. On the other hand, workers generally remain covered by workers’ comp when they go on shorter breaks, such as coffee breaks. Ultimately, the question of workers’ comp coverage during a work break is highly dependent on the specific facts of each case.

Another potential grey area is the attendance at a company party. If you are injured at your employer’s holiday party, for example, you most likely will not be eligible for workers’ compensation benefits. This assumes, however, that the event was held after regular work hours and attendance was voluntary. If not, the event may appear to be within the scope of employment, and therefore covered by workers’ comp. Again, the determination of coverage in situations like these is very fact-specific, and the outcome will vary from one case to another.

Exceptions when the employee is injured at work

Even if an accident occurs at the workplace and during regular work hours, the resulting injury still may not be covered by workers’ comp.

As we’ve written about before, workers’ comp is generally not fault-based, meaning that an employee could receive benefits even if they were to blame for the accident. However, this is not true if an injury results from the employee’s impairment due to drugs or alcohol. Generally speaking, workers’ comp claims are barred if the worker is found to have been under the influence when the injury occurred.

Furthermore, while employees may be forgiven for accidental injuries, they are not covered for their own intentional and reckless acts. This means a worker won’t be able to receive workers’ comp benefits if they are hurt while fighting, horsing around, or otherwise engaging in dangerous behavior.

New York workers’ comp attorneys

Often the question of what is and isn’t covered by New York’s workers’ comp laws hinges on seemingly minor details. As such, it is important to have a knowledgeable workers’ comp attorney to advocate for your eligibility if you are ever injured on the job.

Feel free to contact our office to speak to one of our experienced workers’ compensation attorneys today.