Workers compensation insurance will generally cover any injury an employee has suffered in the course of performing their work duties, if they were following proper safety guidelines and company policy at the time. There is some flexibility here and it's often handled on a case-by-case basis.
But there are also some factors that may instantly invalidate any workers compensation claim. These include:
- Self-inflicted injury. This covers certain acts of negligence and recklessness. But it can also cover employees who are injured after engaging in a fight with another employee. This can mean an employee who started the fight, or an employee who escalated a conflict rather than avoiding it. Use of alcohol at work can also result in a "self-inflicted" injury — as it's not hard for lawyers to prove that the injury never would have happened had the employee been sober.
- Injuries suffered while the employee was committing a crime. This may seem like an extreme example. Not many employees are going to injure their hand while breaking into the office. And if they do, they're not likely to tell you about it to try and get on workers compensation. But it can also extend to anyone bringing a controlled substance to the workplace or committing other minor crimes.
- Injuries suffered off-the-job. This applies if your employee is just helping out — such as bringing in a truckload of lumber or tools — and they suffer an injury in the process. If they're not on the clock, workers compensation will not cover them. It doesn't mean they can't sue you for damages. It just means workers compensation won't be the policy covering them. Don't ask your employees to work off the clock. And don't let them volunteer to work off the clock, no matter how small the task.
- Any injury suffered in violation of company policy. Suppose you run a metal shop. You've told your employee time and again to roll up those loose shirt-sleeves. You have signs reminding them to do just that. They refuse, and eventually suffer an injury for it. Workers compensation won't cover that.
The rules are straightforward: Follow the law, follow company rules and guidelines, and you probably won't have to worry about workers compensation claims being invalidated. Your insurer just wants to know that everyone was trying their best to create a safe workplace.
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