What Does Workers’ Compensation Not Cover?

Workers’ compensation allows you to recover benefits to pay for medical expenses arising from injuries sustained in a workplace accident. Depending on how long your injuries keep you out of work, you may also be able to get compensated for lost wages.

You can request benefits for many on-the-job injuries, such as back, neck, knee, or repetitive stress injuries. However, some types of harm are not covered under workers’ compensation. These can be injuries stemming from unlawful conduct or those sustained outside the scope of your employment. Additionally, benefits might not kick in if you failed to follow the proper procedures after being injured.

If you were hurt on the job and want to pursue compensation, please speak with a member of our Atlanta team for help determining your eligibility. Call The Law Offices of Nathaniel F. Hansford, LLC at (770) 741-2825 or submit an online contact form today.

When You May Be Eligible for Workers’ Compensation Benefits

Eligibility for workers’ compensation benefits depends on several factors, including when the accident occurred and what caused it. Generally, if the incident happened during the course and scope of your work, you may receive financial recovery.

Examples of injuries covered under workers’ compensation include:

  • Those sustained while performing job duties during working hours,
  • Occupational-related diseases, provided that a link exists between the condition and the job and the disease is not commonly suffered by others,
  • Aggravated on-the-job injuries,
  • Repetitive motion injuries, and
  • Catastrophic injuries.

Workers’ compensation benefits may cover lost income if you miss work for more than 7 days because of your injury.

It will also take care of medical expenses such as:

  • Doctor bills,
  • Hospital bills,
  • Physical therapy,
  • Prescriptions, and
  • Travel expenses necessary for receiving care.

When You Might Not Be Eligible for Workers’ Compensation Benefits

Several situations exist in which you might not be able to receive workers’ compensation benefits or when your claim may be denied because proper procedures weren’t followed.

Below are examples of injuries, circumstances, and actions that could disqualify you from obtaining benefits:

  • Commuting to and from work: Under the “going and coming rule,” you are ineligible for benefits if your injuries resulted from an accident you were in while you were driving to or from work. However, exceptions exist if you were driving specifically for work.
  • Accidents caused by intoxication: Georgia law says that workers’ compensation claims may be denied if the individual was under the influence of drugs and/or alcohol at the time of the incident. Your employer may require that you take a chemical test to determine whether you were intoxicated. If you refuse the test, you will be ineligible for benefits.
  • Willful misconduct: Workers’ compensation does not cover injuries resulting from an employee’s intentional actions or misbehavior. For instance, your claim can be denied if you were fighting or messing around at work or tried to hurt yourself or someone else.
  • Late reports or claims: You are required to timely report your accident or file a claim before a deadline. If you do not tell your employer that you were injured within 30 days of the incident or did not request a hearing with the State Board of Workers’ Compensation within a year, your request may be denied.
  • Refusing a job: If your employer offers you a suitable position and your treating physician clears you to perform the duties, you must attempt the work. Refusing the role can result in a suspension of your benefits.
  • Injuries sustained when performing unassigned duties: For the most part, workers’ compensation benefits are recoverable when an accident occurs while you are carrying out the functions of your role. If you are injured while doing tasks not specifically assigned to you, your request may be denied.
  • Accidents occurring outside of work hours: Harm you suffered when off the clock, such as while on your break or lunch, is not considered an on-the-job injury.
  • Heart attacks and strokes: You may not be eligible for benefits if you suffered a heart attack or stroke on the job unless the condition was directly linked to the tasks of your role.
  • Pain and suffering: Workers’ compensation covers medical expenses and lost income, but not pain and suffering resulting from your injury. These damages may only be recovered in a personal injury lawsuit, which you can file against a third-party but not your employer.

Schedule a Consultation with a Member of Our Team

Unfortunately, several situations exist where workers’ compensation does not kick in. If your request is denied because the insurer says you are ineligible, you may request a hearing to challenge the decision.

Our team in Atlanta can help appeal a denial. Speak with us by contacting The Law Offices of Nathaniel F. Hansford, LLC at (770) 741-2825.