What is not covered by worker’s compensation?

Imagine you’re a construction worker, working hard to complete a project on time. You’re up on a scaffold, hammering away, when suddenly the scaffold collapses beneath you. You fall to the ground, suffering from a broken leg, fractured ribs, and a concussion. You’re in pain, unable to work, and unsure of what to do next.

Thankfully, you have worker’s compensation insurance to fall back on, right? Not so fast. Worker’s compensation in Iowa is supposed to cover employees for any health condition caused by work activities, including diseases and hearing loss. But there are fine lines and gray areas for what is covered by worker’s comp and what can be denied. If an employee is injured in the workplace, what is not covered by worker’s compensation? 

Pre-Existing Conditions

Workers’ compensation may not cover injuries that are related to a pre-existing condition. If an employee harvesting soybeans has a pre-existing back injury and sustains a new back injury while lifting a heavy object at work, workers’ compensation may not cover the new injury.  Iowa Workforce Development states that an pre-existing illness or injury may be covered if it can be proven the employees’ work duties aggravate or worsen them – however, it would be up to the employee to provide enough evidence of the link between their work activities and worsening condition. 

Injuries From Horseplay or Intoxication

Playing a prank on a co-worker or celebrating a  team member’s birthday with a few beers before signing off for the day may seem like fun at the time, but an employee who gets injured under these circumstances takes a substantial risk of being denied their claim. Workers who are injured while engaging in horseplay or while under the influence of drugs or alcohol may find that their injuries are not covered by workers’ compensation. It’s important for employees to follow safety protocols and work within the guidelines of their job to avoid these types of situations, as they could end up with costly medical bills as a result. 

Self-Inflicted Injuries

Workers who intentionally hurt themselves on the job will find that workers’ compensation does not cover their injury. If an employee is being purposely negligent when using equipment or chemicals, or in extreme cases, deliberately injuring themselves to get time off work, they can not expect to be compensated for their costs. Needless to say, an employee should never take such risky measures in the workplace, especially in order to take time off. 

Injuries That Occur During Commuting

The majority of workers in Iowa will use their own car to get to work, and some will spend several hours a day on the road. Getting into a car accident to or from work is a real possibility, but injuries that occur while commuting to and from work are generally not covered by workers’ compensation. There could be an exception if the employee is traveling for work, such as driving to a meeting or visiting another branch of the company. In those cases, workers’ compensation may cover their injuries.

Mental Health Conditions

According to Iowa Workforce Development, worker’s compensation covers injuries and diseases caused by work activities that go beyond the normal wear and tear of the body. Mental health conditions, such as depression or anxiety, that are caused by an employee’s job may not be covered by workers’ compensation. However, if the employee is experiencing mental health issues as a result of a physical injury or trauma at work, workers’ compensation may cover their treatment. The mental anguish and other types of mental health issues that may follow an injury, such as post-traumatic stress, can be claimed under the law as pain and suffering. 

Injuries That Occur During Lunch or Breaks

If an employee is onsite at work, coverage for injuries while taking a break from work duties can be a gray area. Employees who are injured during lunch or on a break may find that workers’ compensation does not cover their injury. There may be an exception if the employee is on the clock and completing a work-related task, For instance, if an employee is fetching a tool from the warehouse during their break and gets hurt in the process, workers’ compensation may cover their costs. 

Injuries That Occur During Off-Duty Activities

Playing a few rounds of golf with co-workers can be a good way to bond with the team and make new friends, but an employee who hurts their shoulder during the game, does worker’s compensation apply? It depends on how the outing was organized and if the employee was required to attend. If employees are injured while participating in an off-duty activity, worker’s compensation may not cover their injury, but if the employee was required to participate or if they were on a company-sponsored outing they might make a successful claim. 

Injuries That Occur While Violating Company Policy

Getting injured while breaking the rules at work doesn’t bode well for a worker’s comp claim. Employees who are injured while violating company policy, such as not wearing required safety gear, or doing required safety checks before operating machinery may find that workers’ compensation does not cover their injury. It’s important for employees to always follow safety guidelines and company policies to ensure that they are protected in case of an accident.

Injuries That Occur During Acts of Violence

Employees who are at risk of physical violence, such as a security guard, may be covered by worker’s compensation if they are injured on the job. For other kinds of workers, pressure on the job  means sometimes employees will lose their cool. But employees who are injured during an act of violence, such as a physical altercation with a coworker or customer, may find that workers’ compensation does not cover their injury. 

Injuries That Occur During Independent Contractor Work

There may be a loophole in worker’s compensation coverage if the worker is an Independent contractor and not a salaried employee. Before accepting work on a job site, it is important for a contractor to find out what kinds of protections they are entitled to and if the company they are working for has any liability if they get injured. 

For instance, repetitive motion injuries can be a common issue, especially for those in positions that require frequent, repetitive tasks. Knowing the specifics about such injuries and how they are treated under workers’ compensation laws is essential. Similarly, construction site injuries carry their own set of complexities due to the nature of the work involved. It’s equally important to be informed about the process for workers’ compensation appeals, in case your initial claim is not successful. Additionally, knowing the right protocol to report a work injury can make a significant difference in the timeliness and effectiveness of receiving compensation. Lastly, in the unfortunate event that you are forced to return to work too soon after an injury, understanding your rights can protect you from further harm and ensure proper healing time.

If you get injured while at work, we can build your case and ensure your claim includes all of the compensation you are entitled to. Contact us or call 515-444-4000 for a free consultation. 

If you’re dealing with injuries sustained in a car accident in Des Moines, you need a Des Moines car accident lawyer to help you navigate the legal system. A skilled lawyer can assist you in obtaining the compensation you deserve for your injuries.