You must meet specific requirements to qualify for workers’ compensation. People injured at work are usually covered by their employer’s workers’ compensation insurance and state laws. But what about those injured off-site? Are they still entitled to benefits?
What Benefits Are Available Under Workers’ Compensation?
Workers’ compensation benefits typically include:
- Replacement income
- Medical expenses
- Long-term or lump sum pension if you are permanently unable to work
- Temporary disability pension while you are unable to work
Requirements for Workers’ Compensation
To satisfy workers’ compensation requirements:
- You must be an actual employee of your employer (i.e., not an independent contractor)
- Your injuries have to be work-related
Processing a Workers’ Compensation Claim
To receive workers’ compensation, you must follow several steps. Specifically, you must:
- Promptly report your injury to your employer. (Some states generally require notice within 2-30 days following the injury. If an injury or illness results over time, you must report it as soon as you realize your work caused it)
- Get medical treatment and follow the doctor’s instructions.
- File your claim with your employer’s insurance carrier. (Your employer must provide insurance claim forms)
- Save all copies of paperwork throughout the whole process.
What Types of Injuries Are Covered Under Workers’ Compensation?
Workers’ compensation is designed to benefit injured workers regardless of whether the accident was their fault or the employer’s. If the injury is work-related, it is covered by workers’ compensation. Typical injuries include:
- Repetitive stress injuries
- Illnesses or diseases that are a gradual result of work conditions
- Traumatic physical injuries
- Repeated trauma injuries
- Mental injuries – when associated with physical injury
- Occupational diseases
Does Worker’s Compensation Cover Off-Site Injuries?
In general, workers will be eligible for worker’s compensation for injuries that occur away from the job site if the injury is work-related. It can be challenging to determine whether an injury is work-related, so courts typically look to see if the employment caused the injury. Off-site injuries covered by workers’ compensation include:
- While traveling, if the employee is a traveling salesperson with no fixed job site, or the employer provides the employee’s transportation through a company car or by reimbursing the employee for travel expenses;
- During a company-sponsored event, such as a Christmas party, as long as it is company-sponsored and not just employees getting together on their own;
- During a company-sponsored recreational activity, such as a company fitness program to increase employee health or a team-building event for the office;
- During a recreational activity to entertain potential clients.
Are Injuries Sustained While on Lunch Breaks Covered?
Generally, worker’s compensation does not cover injuries during lunch breaks. However, there are several exceptions to this rule. Courts consider whether the employer benefited from the employee’s actions. Examples include:
- Purchasing a sandwich for a boss so that they can continue working at his desk might be considered an errand for the employer and covered. Nevertheless, if the employee runs personal errands during their break and offers to pick up food for coworkers, that is probably not covered.
- A company cafeteria would provide a benefit to the employer because employees wouldn’t have to travel off-premises for lunch and could return to work more quickly. Injuries occurring in the lunch room would also be covered.
Does It Matter When and Where the Accident Happened?
Most employees are not covered when they commute to work. As a result, their workday does not begin until they arrive at their workplace or any other employer-controlled location.
Commuting may be covered if the employee is performing work duties while driving. An employee might be talking to a client or their boss while driving. It may be considered work-related.
As a rule, employees whose jobs require travel are covered while engaged in work-related travel.
Lastly, some workers may be injured at work-sponsored off-site events. In this case, workers’ compensation may apply. They might also be able to bring a personal injury claim against the entity that owns the site or organized the event.
The Injury Must Be Work-Related to Qualify for Workers’ Compensation Benefits
A worker must have been injured while performing work duties for their employer to qualify for a claim. Even though off-site injuries complicate the issue, they can still qualify for workers’ compensation.
An employee attended a two-day seminar. After dinner, the employee fell and broke her leg as she returned to her hotel. Even though the injury occurred after hours and off-site, it is covered by workers’ compensation.
This injury is compensable since the training was incidental to the work performed. A basis for denying liability may exist if the employee deviated from the training session itinerary, e.g., leaving early, going to a bar, and square dancing for hours before breaking her leg. Case law has developed in the area of “in the course of employment” to identify many exceptions.
During the journey home from a three-day conference, a social worker is involved in a motor vehicle accident. Another driver rear-ends the employee, causing back and neck injuries. The injury is covered even though the injury did not occur on the employer’s premises or in the employer’s vehicle. This injury is compensable because the conference was incidental to the work performed.
During her lunch break, an employee decides to walk to the local convenience store. Several blocks from the employer’s premises, the employee trips on the curb. She falls and injures her knee. In this case, the employee’s injuries are not compensable because:
- The employee was on her break.
- She was running a personal errand.
- She was on a public street several blocks from her employer’s premises.
The employee was not engaged in the course of her work activity at the time of the trip and fall, and her injury did not occur on the employer’s property.
Each situation is unique. There is no one-size-fits-all answer to a contested claim because every human being has a different perception. However, these scenarios outline some clear principles and how they apply in the real world.
Factors for Injuries that Occur Off-Site
When employees are off-site, compensability is determined by whether they are performing their duties. Employees may need to receive training off-site when their job duties require ongoing education. When an employee is injured, they must prove two elements of compensability: that the injury occurred during and as a result of their employment.
Who Is NOT Covered by Workers’ Compensation?
Workers’ compensation benefits are not available to some classes of workers. Examples include:
- Business owners
- Independent contractors
- Federal employees (under the state’s scheme)
- Domestic employees in private homes
- Farm workers
- Maritime workers
- Railroad employees
- Unpaid volunteers
Workers’ compensation laws vary from state to state. For instance, California workers’ compensation laws may differ from those in other areas.
Do I Need a Lawyer for Help with Off-Site Injury Claims?
Workers’ compensation laws are state laws, so they can vary from state to state and be confusing. You should file the proper workers’ compensation insurance forms required by your employer as soon as you are injured on the job.
If the claim is denied, an experienced workers’ compensation attorney familiar with workers’ compensation law can advise you of your rights and options in contesting the denial of your claim. If necessary, a lawyer can represent you in court.