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Injuries That Are Not Covered By Workers’ Compensation

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There is a fairly widespread belief that any injury that occurs at work must be covered under workers’ compensation. But that is not true. There are several categories of injuries that happen at work which simply are not compensable. Injuries that do not arise out of employment are not covered in workers’ compensation. Not only must an injury occur during work, but it must arise out of work. In every state, there are a number of useful doctrines that help explain and expand on the definition of “not arising out of employment” for traumatic injuries.

Idiopathic Claims

The concept of idiopathic applies when the employee has a preexisting medical condition which is the true cause of the injury. For example, an employee with severe osteoarthritis is walking down the corridor at work when his knee locks, without striking anything or falling. The doctor examines and advises that further knee damage was caused by the act of walking on account of severe osteoarthritis. This is a classic idiopathic claim because the injury was entirely personal to the employee, not caused by work.

Deviation from Employment

This doctrine has two major applications. The first applies to an activity that is either unconnected to work or so far afield that a reasonable person would never do it. For example, a lawyer is outside his office and calls a colleague on his cell phone who is working at his desk, asking the colleague to come outside and help carry work files into the office. The colleague decides not to walk down the steps or take the elevator but instead opens his window and jumps 20 feet to the ground, breaking his leg. This activity of jumping from one’s window is so hazardous that no reasonable person would do it. The injury clearly happened during work but it would be a deviation from employment. An employer should not have to insure against inherently dangerous activities that no reasonable person would undertake.

The second type of deviation from employment is found in connection with travel that is unconnected to work. For example, an employee works as a pumping station operator, driving throughout the city. He got permission from his supervisor to stop and get his mail in the morning as he was driving along the main road in town to the next pumping station. He fell and fractured his pelvis returning to his municipal vehicle parked in the post office lot after getting his mail. This employee’s injury would be considered to be a major deviation because the activity of getting his own mail, even if it was permitted, had no connection to his work.

Intentional Self Injury

Employees who deliberately injure themselves will almost always be denied compensation. If an angry employee punches a wall in an argument at work and breaks her hand, that injury would not be compensable because the action of punching a wall is highly likely to cause self-injury. In the same way, if Employee A assaults employee B and Employee A is injured in that process, courts will almost always find this to be self-inflicted and not compensable. The injury to Employee B, of course, would be covered as the victim of an assault.

In general, cuts, scrapes, small wounds, or even a single headache are insufficient to be covered by workers’ compensation. If you are injured at work, and the contents of a first-aid kit completely remedy your injury, the injury is usually not severe enough to warrant a workers’ compensation claim. However, if you are exposed to a chemical that causes routine headaches, this is could be considered an occupational disease that amounts to a workers’ compensation claim. Commuting is not considered in the course of your employment. Therefore, injuries suffered while commuting, with rare exceptions, do not give rise to a workers’ compensation claim. Similarly, when you are out for lunch, you are outside the scope of the workers’ compensation system. Horseplay and fighting also do not fall within the scope of your employment, or injuries caused by alcohol or drug use, so injuries sustained during these activities generally are not workers’ compensation claims.

At Lee Injury Law, we focus on helping you obtain the best possible medical care to get back to work as soon as possible, getting all of your benefits while you are out of work or on light duty, and then getting all of the money you are entitled to by law, through a settlement or the hearing process. We bring many years of experience in dealing with the South Carolina workers’ compensation system, and we provide the highest level of personal attention to each and every client.

To find out how you can benefit from the services of our highly experienced Columbia workers’ compensation attorney in Greenville, call Lee Injury Law for a free legal consultation at 803-500-0000.

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