Workers’ Insurance Scope of Coverage

Scope of Coverage

The workers’ compensation insurance scope of coverage varies from state to state in accordance to occupation. Some states exempt certain workers’ category including; independent contractors, domestic employees and agricultural employees. However, in some states where employers employ above the limits of exemption, these categories become part of the coverage.
Hire an employment law attorney in your area to determine if your employees are entitled to the workers’ compensation benefits. Bear in mind that if your employees are without the workers’ compensation insurance, you act as the insurance agency for them. They can also bring a civil claim against you or your business.

No more Civil Lawsuits

The workers’ compensation policy is designed as a substitute for a lawsuit by an employee against his or her employer. Without suing the employer in court, employees are entitled to the workers’ compensation benefits. This is true regardless of who was at fault for the accident or the injury.
Before this, employees often go to court to claim compensation for their work-related injuries. With the workers compensation policy, employees are automatically entitled to workers’ compensation, at the same time, protecting the employer from employee lawsuits.

The work-related injuries eligible for claims:
1. Includes preexisting bad health conditions that the workplace aggravates or accelerates. Example is an old back injury, even if the employee is unaware of the pain until later.

2. Injuries caused during lunch hours, breaks, and such work-sponsored activities like company outings, picnics, programs, sport festivals. This also includes at-work injuries caused by company facilities, such as a chair, a table, a locker or a filing cabinet in the company office, mess room, lounge, or anywhere within company premises.

3. It also covers diseases like lung cancer, contracted by exposure to toxins at work resulting from normal working conditions. There are hazardous chemicals in some working environments that need special safety protection. These are highly recommended for coverage under the workers compensation law.

4. The coverage also includes injuries that resulted from physical and mental strain brought on by increased work duties or work-related stress. There are states that include the coverage of employees who develop a disabling mental condition due to the demands of the job or even the constant harassment of a supervisor.

Some injuries that are not covered by the workers’ compensation policy

1. There some states that strongly disqualify claims for an injury sustained during horseplay at work. They believe that proper conduct of workers in work stations would ensure effectively the company’s safety measures.

2. Employees are injured while intoxicated or who deliberately inflicts injury on himself, are not eligible for benefits of the workers compensation policy.

3. Injuries sustained by an employee while traveling to and from work are not generally entitled to benefits.

However, injury benefits are extended to employees who are provided with the company means of transportation, such as a car or paying the employee’s cost of commuting, including positions that require travel to perform his or her duties and responsibilities.

4. Once a worker leaves the employer’s premises for a personal errand and is injured, he or she is not entitled to the workers’ compensation benefits.

On the other hand, benefits are also awarded to employee injuries incurred on non-business employee conveniences such as;

a. While returning from company-sponsored education classes, seminars, symposiums, training stints, travel rewards, or any company sponsored activity that requires travel

b. While on company premises and goes to the restroom or visits the cafeteria for a break

c. By stepping out to smoke a cigarette into a smoking area and is injured. The boards and courts of the workers’ compensation typically recognize that employers also benefit from these employee conveniences and have included this in the insurance scope of coverage.