Not every type of injury that happens at work falls under the workers’ compensation program. You are eligible to receive benefits for an injury that you sustain only within the scope of your employment.
If you are hurt at work but the injury is not directly related to your job duties, workers’ compensation may deny your claim. Here are some scenarios that the program may not cover.
Employees generally cannot collect compensation for an accident that takes place as they are going to or from work. However, individuals who work at more than one location may be exempt from this rule because travel is a fundamental component of their job. Salespeople, service technicians, or traveling nurses may be eligible for benefits after an accident en route to work.
In general, an accident from horseplay or rough-housing is non-compensable. When you physically interact with a coworker, it is not within the scope of your employment. The fact that an employer may be aware of employees regularly engaging in horseplay is immaterial.
An injury while you are taking a break in your workplace’s break room may fall under workers’ compensation. However, if you take your break off site or you engage in a physical activity that is unrelated to your work, it will probably not be possible to get coverage.
Ultimately, every situation is slightly different, and there are a few gray areas instead of uniform black and white rules. A claims examiner will review the facts of each case on its merits to determine whether an injury is eligible for benefits.