You May Not Have to Pay WC Insurance Benefits If …

December 3, 2018 No Comments

Under certain circumstances in the USA, your company may not be responsible to pay workers compensation benefits to an employee who was injured on the job.   These special circumstances vary from state to state, but generally these exceptions include:

  • Work related injuries caused by a dangerous or defective machine, tool or piece of equipment.  The manufacturer of the dangerous or defective product may be responsible for the damages.  If this can be proven, the employee may also be entitled to additional payments from the manufacturer that are over and above the statutory workers compensation benefits.
  • Work related injuries to one of your employees what was caused by a “non-employee” third party (e.g. visitor, contractor, customer).  In this case, the third party may be responsible for the damages caused by their actions.  You probably don’t want your workers compensation insurance company suing one of your good customers.  If a customer was responsible to an injury to one of your employees, be sure to tell your insurance company claims adjuster that you would prefer that the insurance company would not pursue legal action against your customer.
  • The employees’ injury was self-inflicted.
  • The injury happened to your employee in a highway vehicle accident that was the fault of the other party. 
  • The employee violated a work or safety rule (such as not wearing the required personal protective equipment).
  • The accident did not take place while the employee was in your employment or on your premises.  Generally, injuries caused by accidents while commuting to and from work are not covered by workers compensation.  Also, I’ve seen some injuries that occurred during a lunch break covered by workers compensation insurance.  That’s why you may want to consider requiring employees to “punch out” during their breaks and for lunch.
  • The accident occurred while the employee was under the influence of drugs or alcohol.  Be sure to have all “post accident” drug and alcohol tests performed immediately after the accident.  Some states do not recognize post accident drug/alcohol test results if the test was performed more than a few hours after the accident. 

If any of the above situations do occur, talk to your insurance companys’ workers compensation claims adjuster (or your claims TPA if you are self-insured).  They will know the specifics of  the workers compensation law that applies in your state and will provide expert advice tailored to your particular situation and jurisdiction.

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