What is a Work-Related Injury?

insurance continuing educationWorkers’ compensation benefits are provided if the injury, death, or disease arises out of and in the course of employment. Where coverage applies depends on where the employee works.

  • If an employee has a fixed place of employment, benefits will be provided for injury, disease, or death while at that location.
  • If an employee, such as a salesperson, has no fixed location, the employee may be covered from the time he or she leaves home until he or she returns home.
  • When a traveling employee checks into a hotel, motel, or into another temporary residence, he or she establishes a “home away from home.” When the employee checks into the temporary residence, he or she is considered to have left the work environment. When the employee begins work each day, he or she re-enters the work environment.
  • Benefits may be available to an employee while not working if the activity is construed as promoting the employer’s goodwill and interest.

The courts have distinguished between work-related injury versus illness and recreational injury. Let’s look at some examples.

Workers’ Compensation Scenarios

William is employed by ABC Construction Company. While working on a new building, William falls from a ladder and breaks his leg. Because the injury occurred while William was performing his job, ABC’s workers’ compensation insurance carrier will cover the medical bills and lost wages from this incident.

Two years later, William is playing in a baseball game at ABC’s annual picnic. He breaks his leg sliding into home plate. This time, the injury arose outside the course of employment; therefore, the workers’ compensation insurance carrier will not cover the loss.

ABC Construction Company holds a charity event to raise money for the local hospital. The owner tells William he must volunteer to sell tickets for one the carnival rides that will be at the event. While he is setting up a booth, William breaks two bones in his left hand when the booth falls on him. ABC’s workers’ compensation insurance carrier will cover the medical bills and lost wages from this incident because the activity is construed as promoting the employer’s goodwill and interest.

Limitation on Benefits

The individual state laws may limit the amount of benefits that employees are entitled to receive to compensate them for their work-related injury or illness. Each state has its own rules for how an injury should be compensated. Some states have a list that affixes a dollar amount for the type of injury. Other states mandate that compensation is based on a scale or rating of injuries or disabilities.

Want to know more about workers’ compensation? Check out our Workers’ Compensation Made Simple in our Insurance Continuing Education Course Catalog.

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