A general rule of workers’ compensation benefits is that they cover injuries and illnesses suffered during the “course and scope” of a person’s employment. That’s true whether an injury or illness occurred due to one incident or over time due to, for example, repetitive movements or continued exposure to a toxic substance.
There are some commonly recognized exceptions that can prevent a person from getting benefits even if they suffer an injury while they’re doing their job. These include “horseplay,” as it’s known in workers’ comp law, being impaired by alcohol and/or drugs and fighting.
Common workers’ comp exceptions may still be covered
If someone is doing any of these things, they aren’t typically within the “course and scope” of their employment. There are still situations, however, when they may not prevent someone from getting benefits.
When it comes to fighting, perhaps a co-worker pushed someone into a hot stove in a restaurant kitchen as they fought over how to make a particular dish. That might be covered since the fight was work related. Note that a fight between employees who simply don’t like each other or have some personal beef isn’t considered within the “course and scope” of employment.
Further, impairment also isn’t always a reason to be denied benefits. Maybe someone’s inebriation had nothing to do with how they were injured. Another tricky situation involving alcohol is when it’s provided at work – maybe as part of a celebration. That’s why many businesses have moved away from furnishing alcohol, even at offsite holiday parties.
What about injuries at company-sponsored events?
A lot of people suffer injuries during company picnics, softball games, volunteer days and “fun runs.” Typically, if attendance and participation in an event is required (not just “strongly encouraged”), an argument can be made that injuries warrant workers’ comp benefits. If employees aren’t required to participate, workers’ comp probably won’t apply.
There are a lot of gray areas in workers’ comp law. When there are disputes between employees and employers and/or insurers, however, decisions by workers’ comp panels and courts often come down to whether a condition resulted from an activity that an employee was engaging in within the course and scope of their employment.
If your employer or their workers’ comp insurer is disputing your claim, it can be daunting to go up against them, even if your claim is valid. This is where having experienced legal guidance can make all the difference in getting the benefits you need and deserve.