What are the two most popular questions related to Workers’ Compensation - Winer Law Group is here to explain them to you.
While workers’ compensation is designed to provide benefits for a wide range of job-related injuries and illnesses, not all situations are eligible for coverage. Understanding what is excluded can help employees and employers avoid misunderstandings and ensure compliance with legal standards.
What is not covered by workers’ comp?
Common Exclusions from Coverage:
Self-inflicted injuries:
Injuries that are intentionally caused by the employee (such as those resulting from a fight they initiated or deliberate self-harm) are typically not covered.Injuries resulting from intoxication or drug use:
If the employee was under the influence of alcohol or illegal drugs at the time of the incident, and it can be proven that this contributed to the injury, the claim is likely to be denied.Injuries during off-duty activities:
If an injury occurs during an activity that is not work-related (e.g., company picnics without a required presence, commuting from home to work), it may not qualify for compensation.Violation of workplace policy or misconduct:
Accidents that happen while the employee is violating safety protocols, engaging in horseplay, or behaving recklessly might not be covered.Mental health claims without clear workplace connection:
Emotional or psychological injuries (like stress or anxiety) may not be covered unless they are directly tied to a traumatic workplace event and supported by medical evidence.Independent contractor injuries:
In most states, independent contractors are not eligible for workers’ comp benefits, unless misclassified or otherwise covered by specific agreements.Pre-existing conditions:
If the injury is found to be entirely due to a pre-existing condition that was not worsened or aggravated by job duties, coverage may be denied.
Who pays for workers’ compensation benefits?
One of the most frequently misunderstood aspects of workers’ compensation is who is financially responsible for the benefits provided. Despite the belief that it might come from employee payroll deductions or government subsidies, workers’ compensation is entirely funded by employers.
Funding Sources Explained:
Employers are required to carry insurance:
In nearly every state, employers must either purchase workers’ compensation insurance through a private insurance carrier or participate in a state-run insurance fund. In some cases, large businesses may qualify to be self-insured, meaning they pay claims directly.No employee contributions:
Workers’ compensation is not deducted from employees’ paychecks. It is considered a business expense and is fully funded by the employer.State involvement (when applicable):
Some states operate their own insurance funds (e.g., California’s State Compensation Insurance Fund). Employers may be required to buy insurance through this fund if private options are not selected or available.Self-insured employers:
Larger employers may apply to become self-insured if they can demonstrate financial stability and the ability to manage claims. These employers typically work with third-party administrators (TPAs) to handle the claim process.
Regulation & Compliance:
State laws determine how coverage must be maintained.
Employers who fail to provide adequate coverage may face severe penalties, including fines and liability for medical costs and lost wages out-of-pocket.
Call Michael Winer – Injury Attorney- (813) 224-0000.
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