Workers’ compensation insures employees for just about any injury or illness that arises in the course and scope of employment. This significant public policy provides for medical care and income replacement for those who are injured. What’s more, it makes no difference whether or not the employee was at fault for the injury.
As with most employment or insurance related issues, however, there can be extenuating circumstances that are considered. In the case of workers’ compensation coverage, some injuries that are related to work are not covered due to circumstances that are specifically excluded by law.
One key exclusion from coverage is an injury suffered reporting to and leaving work. This is true even if the injury occurs in the parking lot or other areas that are adjacent to the employer’s business premises. On the other hand, if the injury is suffered on the premises, it would still be covered. For example, an employee who slips and falls in the stairwell while exiting the employer’s place of business is covered. Again, it does not matter whether or not the employee was at fault for the fall.
An exception in which employee fault is considered is when an employee is under the influence of drugs or alcohol, and the cause of the injury is attributable to such influence. Conversely, if an impaired employee is injured by an equipment failure or other cause out of his control, the fact that he was under the influence does not matter. In these situations, however, the law states that the immediate presumption is that impairment did cause the injury. It is up to the employee to demonstrate otherwise.
Another time and place in which work-related injuries are not covered is during social activities. Company picnics, for example, are a place where injuries can occur. They often involve sporting or recreational activities in which injuries are not uncommon.
If an employee has a pre-existing medical condition that worsens during the course of employment, it will not normally be covered. There is an exception to this exception if a significant and identifiable aggravation of the condition occurs in the course and scope of employment.
Injuries that occur during work breaks outside of the employer’s premises are also not covered. For a work break injury to be covered, the break must be approved by a supervisor and occur inside the employer’s facility. Alternatively, if a supervisor instructs an employee to take a break and go to the corner grocery for snacks for the work crew, that would constitute work time and an injury outside the facility would be covered.
Mental illness is not covered by Oklahoma workers’ compensation unless it is caused by a physical injury that is covered.
An important thing to remember about exclusions from coverage is that particular circumstances can sometimes outweigh the exclusion. That is why it is important to consult a workers’ compensation attorney when you have been denied coverage for a work-related injury or illness. If you have been injured at work, call us today at 918-582-2500, or contact us online, for a free consultation with an experienced attorney.