The Work-Related Requirement in Workers' Compensation Claims
One of the most commonly disputed elements of a workers’ compensation claim is whether the accident or illness happened on the job. To be eligible for benefits, a worker’s injury or illness must have arisen out of their employment. In many cases, this is easily apparent. If a worker suffers a crushed limb while operating machinery in a factory, or if a worker strikes a coworker while driving a forklift, these victims clearly were injured on the job. Other types of accidents and injuries may present more challenging questions.
The Going and Coming Rule
The going and coming rule for workers’ compensation claims states that a worker is generally not eligible for benefits if they were injured while commuting to or from work.
The going and coming rule is perhaps the most notable exception to workers’ compensation coverage. Generally, it provides that a worker is not eligible for these benefits if they suffered an injury while they were commuting to or from the job. Some exceptions may apply, though, such as when a worker is performing a special errand for the employer or traveling on a business trip. If they are driving a company vehicle or required to use their own vehicle as part of their job, they also may be covered by workers’ compensation. Special rules apply to people who travel for their job or work in a variety of locations. Determining whether an exception applies will require a detailed, fact-specific analysis.
Injuries During Lunch Breaks
If you are off the clock and outside your workplace during your lunch break, you probably will not be eligible for workers’ compensation benefits if you are injured during that time. However, you may be covered if you are performing an errand for your employer during your lunch break.
Workers’ compensation benefits may extend to employees who are injured during their lunch break if they are still on the property of the employer during that time. If they were engaging in a personal activity that violated company policy, though, they probably will not be covered.
An employee may be covered for an accident in which they were at fault, even if they were violating a company policy. On the other hand, they may not be covered if the accident happened because they were drunk or drugged. Workers’ compensation usually does not cover criminal activity or deliberate attempts at self-harm. It may or may not cover injuries caused by horseplay with other employees or deliberate violations of company policies. Eligibility in these situations may come down to whether the employee’s supervisor condoned the behavior or whether it regularly occurred in the job setting.
Company Events Outside the Workplace
Some larger businesses encourage employees to attend employer-sponsored events outside their physical workplace. These may include organized recreation like sports events or holiday parties. The general rule is that a worker is covered for injuries sustained at these events. Benefits may not apply in some states if attendance at the event is not mandatory or essentially mandatory.
Cumulative or Aggravated Conditions
Some job-related conditions develop over a long time period, especially illnesses and psychological injuries. Different states take different approaches to coverage of mental health issues, which are not always easy to tie to a job. If conditions in the workplace aggravated a pre-existing condition, you should be able to get benefits for the aggravation, although not for the underlying condition. In this type of situation, it may be especially important to consult an attorney, who can help you document causation and determine a strategy for pursuing benefits.