What injuries are covered by workers’ compensation?
Most workers’ compensation laws use “compensable injuries,” or a similar term, to describe the injuries covered by workers’ compensation.
In most state statutes, an injury becomes a compensable injury when two elements are both met:
- An injury or illness arises out of or in the course of employment, AND
- The injury or illness is causally connected to the course of employment
The burden of proof and the standard used to evaluate a causal connection varies depending on the state, but expect a two-pronged test of this type to apply across state laws.
To help explain how this two-step test operates, consider a few examples.
A warehouse fall
Your employee visits your warehouse to retrieve some sample products for an upcoming trade show. The employee climbs a ladder to pull the products from a high shelf. When coming down the ladder, the employee falls and breaks her arm. The break requires surgery and a hospital stay to successfully repair the arm.
First, the employee was clearly acting in the course of employment when the injury occurred. She was physically at your business location performing actions for the benefit of your business.
Note: Her job description and typical duties are irrelevant to the analysis. Whether or not she should have been climbing a ladder plays no role in determining whether or not the fall is covered under workers’ compensation.
Because the employee was injured in the course of her performing work for your business, the first prong of the test is satisfied.
Second, a causal connection between the injury and the course of employment exists. The injury was caused by a fall from a ladder. The employee climbed the ladder to get a product off a shelf. The employee needed the product to prepare for a trade show. Trade show preparation is an act within the course of her employment. There is a clear causal link in this chain of events that led to the injury.
Because a causal link between the injury and employment exists, the second prong of the test is satisfied.
The warehouse fall is a compensable injury because the two elements of a compensable injury are met. Accordingly, your business is required to cover expenses caused by the fall under workers’ compensation.
Your employee is driving home from work. She stops at a stop light, and a delivery truck slams into the back of her car. Your employee suffers a neck injury.
The employee was not injured in the course of her employment. Transportation to and from work is not considered working time, or an action taken in the course of employment.
Accordingly, the first element of a compensable injury is not met, and your business is not required to cover the injury under workers’ compensation.
Subsequent injuries and illnesses
In addition to the initial injury or illness, most states require employers to cover injuries and illnesses that naturally arise from the compensable injury. Examples of naturally arising injuries or illnesses include complications from the injury or exacerbations of existing injuries.
For example, if the employee who fell off the ladder contracts an infection during the hospital stay, the infection will likely be considered a compensable injury under workers’ compensation laws.
Offsite location and work events
Location, where an injury occurs, is less important than the nature of the employee’s conduct when the injury occurs.
For example, if an employee injures herself in a hotel room while on work travel, workers’ compensation covers the injury.
Alternatively, if an employee injures herself in your business’ gym, on her personal time, workers’ compensation will not cover the injury.
Travel for work is considered work in the course of employment. Using company gym facilities is not considered the course of employment. In both instances, location plays no role in the analysis. The employee’s purpose is the key element.
Similarly, work-related entertainment and company events are typically considered work in the course of employment. Holiday parties, offsite company celebrations, and customer dinners are all considered course of employment activities.
Keep this in mind as you plan activities for your employees. If you plan activities that expose employees to the risk of injury, you may be required to cover those injuries under workers’ compensation.
Note: Even if you have your employees sign a waiver before participating in a risky company activity, you will not relieve your company from its workers’ compensation obligations.