You are a small business owner with a couple dozen employees. Last week, one of your long-time employees slipped and fell while walking through the breakroom. Now he has filed a workers’ compensation claim.
Q: How do I know whether an injured worker is covered by workers’ compensation?
A: Determining whether or not your workers are covered by workers’ compensation can sometimes be complicated. Generally, there are two main factors that determine covered status: first, whether the person is an employee (as opposed to an independent contractor, for example) and second, whether the injury occurred as a result of employment.
It should be noted that neither of these factors is an absolute guarantee that the worker will be covered by workers’ compensation. For example, depending on the rules in place in your state, some employees (such as agricultural workers) are not covered by workers’ compensation. Also, if the injured worker was intoxicated at work or intentionally injured him- or herself, the worker may not be covered by workers’ compensation.
Q: If an employee is receiving workers’ compensation benefits, but returns to work, does the employee still get to receive workers’ compensation benefits?
A: The answer to this question is “maybe.” If the return to work enables the employee to receive wages equal to or greater than he or she was earning prior to the injury, then it is likely benefits will be stopped. If, however, the employee is still experiencing a wage loss due to his or her injury, he or she may continue to receive wage loss benefits, although the benefits will most likely be for a lesser amount.
Q: Can an employee recover workers’ compensation benefits, no matter what he or she did, because it is a “no-fault” system?
A: No. Although most injuries are covered by workers’ compensation, that does not mean that employees have free reign to injure themselves, or act in any manner in which they choose, and then collect benefits. Generally, if an employee sustains injures as a result of intoxication or illegal drug use, benefits may not be payable.
Q: Can an employee recover workers’ compensation benefits, even if he or she was not actually at the workplace when injured?
A: The answer to this question will depend on the laws in your particular state, and the facts of the specific case. Generally speaking, if the injury “arises out of” and occurs “within the scope of employment,” it is covered. For example, if an employee is a traveling salesperson and is injured in the hotel where he or she is staying for business purposes, compensation may be appropriately paid.
Similarly, if an employee is running an errand that takes him or her outside of the workplace, at the request of the employer, compensation benefits may be payable if an injury occurs in the course of running that errand. If the employee is on a business errand, but has stopped or deviated from that errand for personal reasons, then a closer examination of the rules and facts is necessary.
Finally, employees injured while attending an employer-sponsored recreational event, like a company picnic or outing, may be able to receive workers’ compensation benefits even though they were not physically on the employer’s premises.
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