What Does Workers’ Compensation Not Cover?

workers compensation

The purpose of workers’ compensation is to cover the expenses of employees who are hurt in the course and scope of employment in exchange for a worker giving up their right to sue their employer for the harm caused while on the job. However, there are many situations that are surprisingly not covered by workers’ compensation in Wisconsin that cause many accidents and injuries to workers around the Milwaukee area every year.

At Gillick, Wicht, Gillick & Graf our dedicated and skilled Wisconsin workers’ compensation lawyers are here to help you and your loved ones after a workplace accident. To learn more about your legal options after an injury, call or contact our office to schedule an evaluation of your case today.

Accidents Not Covered by Workers’ Compensation

Generally speaking, workers’ compensation in Wisconsin covers the cost of injuries that arise out of or occur within the course and scope of employment. In other words, an accident is covered if an employee is hurt while engaging in an activity or performing a task for the benefit of the employer. This rule is often used to determine whether an accident should be covered under workers’ compensation benefits, and some of the most common situations when an injury is excluded from coverage include the following:

Coming and Going Rule

Travel to and from work is typically not covered by workers’ compensation, as an employee is not considered in the course of their employment when going to or returning home from work. The coming and going rule also applies if an employee leaves their worksite for lunch and an accident occurs.

Exceptions to this rule include when an employee leaves to pick up lunch ordered by the employer for their workers and accidents that occur between the employee parking lot and the building. Accidents are also covered if an employee does not have a fixed worksite, is driving a company vehicle, is traveling for business, or is performing another task for the benefit of the employer.

Intoxication

Accidents on the job are also not covered if the employee injured was intoxicated at the time of the injury, and the intoxication contributed to the accident. Intoxication includes being under the influence of alcohol or controlled substances while at work, but a worker may still be eligible for workers’ compensation benefits if they were impaired at the time of the accident, but the impairment did not contribute to the injuries.

Intentional Acts & Horseplay

Any injuries caused by horseplay at work are typically not covered by workers’ compensation in Wisconsin. The reasoning is that horseplay on the job does not further the course of business for the employer and therefore should not be covered if an injury occurs. The same reasoning applies if an employee is injured by engaging in an intentional act, such as fighting, while at work.

However, a worker may still be covered by workers’ compensation if they are hurt by the horseplay or intentional act but were not directly involved in the action. For example, if two employees are engaging in horseplay and accidentally injure a third person, that third person may qualify for workers’ compensation while any injuries that happen to the two workers horseplaying will not.

Pre-existing Conditions & Acts of God

Workers’ compensation only covers injuries that occur while on the job, and it does not cover pre-existing conditions that are not aggravated by a work injury. This is often an issue when the injury is one that arises out of repetitious movement or occurs soon after a worker begins new employment. Similarly, injuries that occur because of “Acts of God” are also not generally covered by workers’ compensation benefits.

Illegal Activities & Policy Violations

Employees are also not entitled to workers’ compensation benefits if they are injured on the job while engaging in illegal activity. The reasoning behind this is that illegal activities are not in the course and scope of employment, nor are they benefiting the employer. Relatedly, a worker cannot collect workers’ compensation if the accident occurred while the employee was violating a company policy, procedure, or protocol.

Independent Contractors

Lastly, it is important to note that workers’ compensation is only available to workers that are classified as employees. Independent contractors are not entitled to collect workers’ compensation benefits, even if they are hurt while in the course and scope of the job. An experienced attorney can help determine whether a worker has been misclassified as an independent contractor when they should be considered an employee and therefore eligible for workers’ compensation benefits.

What Are Your Legal Options?

If you or a loved one has been injured on the job but is being denied workers’ compensation benefits, it is important to know that you have legal options. The first option is to secure an experienced attorney to review the facts of the case to determine whether you should actually be entitled to workers’ compensation benefits for your injuries. An attorney can advocate for your right to compensation while you recover after an accident.

The second option is to file a personal injury claim against those responsible for the accident. Compensation for a personal injury claim differs from the benefits offered through workers’ compensation. Personal injury damages cover all economic and non-economic harm, which includes the following:

  • Medical bills
  • Lost wages
  • Property loss
  • Loss of future income and earning capacity
  • Pain and suffering
  • Emotional distress
  • Disability
  • Disfigurement
  • Loss of enjoyment of life

Many people have questions about workers’ compensation in Wisconsin. To learn more about your rights, talk to an attorney at Gillick, Wicht, Gillick & Graf today.

Talk to Our Office Now

Have you or someone that you know been injured on the job or have questions about whether injuries that you suffered are covered by workers’ compensation in the Milwaukee area? If so, the experienced and knowledgeable Wisconsin workers’ compensation attorneys at Gillick, Wicht, Gillick & Graf are here to help. Call the office to speak with one of our proficient attorneys today and schedule a free, no-obligation initial consultation of your case.