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Injuries That Are Not Covered by Workers’ Compensation

by | Apr 29, 2014 | Legal, Medical, Workers' Compensation

When you are injured at work, the general rule is that any injury occurring in the course of your employment will be covered by your employer’s workers compensation insurance.  However, there are some exceptions to the rule.

Cases that are not covered by workers’ compensation fall into two categories:  injured workers who are not covered by workers’ compensation law and injuries that are not covered by workers’ compensation.  The distinction may seem complicated, but it is an important distinction that has legal implications.

In a case where the employee is not covered by workers’ compensation laws, they will have to seek an alternate legal remedy because they cannot utilize the workers’ compensation system.  Some examples are federal employees, household workers, railroad employees, fishermen and longshoremen, and others.

Independent contractors are also not covered under Nebraska law.   However many employers declare that their workers are independent contractors when they may found to be an actual employee and covered under workers compensation.

In a case where the insurance company is arguing that the injury itself is not covered by workers’ compensation laws, the claimant may have the option of disputing this through the workers’ compensation process.  The two primary types of injuries that are not covered by workers’ compensation are:

Injuries not arising out of and in the course of employment

If you were injured while you were doing a task that is not part of the “course of your employment,” it will not be covered by workers’ compensation.  A complicated example of this is an injury from a car accident.  When an individual is driving a car for work, but then deviates to engage in personal business (going to the bank, picking up their child from school, stopping to grocery shop) and is involved in a car accident, the insured worker may not be covered by workers’ compensation insurance because they were not injured in the course of their employment. 

However there are many exceptions to the rule.  You should always speak to a workers’ compensation attorney to determine proper coverage.

Injuries caused by willful negligence of the employee

Sometimes an insurance company denies a work injury claim because the employee caused their own injury through willful negligence.  It is important to remember that you can still file a claim if you caused your own injury. However, if the negligence that led to your injury was willful and intentional, you will not be able to file a claim.  The most common example is an employee injured while working under the influence of drugs or alcohol.  This behavior is intentionally negligent, and any injury that results to that negligent employee will not be covered by workers’ compensation.

As you can see by the above examples, these issues are legal questions that can have a great deal of gray area.  Even if your claim has been denied by an employer/insurance company, you should still speak to an attorney about your case to determine whether you should fight back against the insurance company.

Sometimes insurance adjusters take positions on your claim that are just wrong.  Attorney Jeffrey Putnam’s office is available to help Nebraskans who were injured on the job.  Call today to schedule a consultation.