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What does workers’ compensation not cover?

On Behalf of | Oct 21, 2023 | Workers' Compensation

According to the South Dakota Department of Labor & Regulation, employers in the state do not have to carry workers’ compensation insurance, making it one of only two states without a mandate.

Workers’ compensation is a valuable safety net for employees, providing coverage for workplace injuries and illnesses. However, it does not cover all injuries and situations.

Injuries outside of the job

Workers’ compensation covers injuries or illnesses that occur in the workplace or as a result of job-related activities. If an injury happens outside of work or during personal time, it typically is not eligible for coverage. In addition, coverage does not extend to injuries that occur off the clock. This includes injuries that happen during lunch breaks or during the commute to and from work.

Self-inflicted injuries

Injuries the employee intentionally causes, such as self-harm or faking an injury, generally do not have coverage by workers’ compensation.

Injuries under the influence

If an employee’s injury is a result of being under the influence of drugs or alcohol, it may not be eligible for coverage. Many workers’ compensation policies have provisions stating that injuries while impaired are exclusions from coverage.

Horseplay and violating company policy

Engaging in horseplay or violating company safety policies can result in injuries that workers’ compensation will not cover. Adhering to safety guidelines and company policies is essential to ensuring coverage in case of an accident.

Independent contractors

Independent contractors do not usually have access to workers’ compensation benefits. The insurance only covers employees.

Pre-existing conditions

Workers’ compensation may not cover injuries or conditions that were pre-existing and unrelated to your job. However, if a work injury worsens a pre-existing condition, it may be eligible for benefits.

Understanding what falls outside workers’ compensation coverage is important for employees. By being aware of the limitations, employees can take the proper steps to report injuries and ensure coverage under the right insurance policy.