What Work Injuries are Not Covered by Workers’ Compensation?

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Workers’ Compensation insurance can be a lifesaver for many employees. Maryland requires that every employer with more than one employee carry this insurance. Certain small agricultural employers are excluded from this requirement, as are sole proprietors, contractors, and partners in a formal business partnership.

Workers’ Compensation is designed to compensate employees who are injured on the job or fall ill from their work environment. The insurance covers medical bills and part of the employee’s lost wages for these accidental personal injuries.

Under Maryland law, an accidental personal injury for Workers’ Compensation is:

  • An accidental injury that arises out of and in the course of employment,
  • An injury caused by a willful or negligent act of a third person directed against a covered employee in the course of the employee’s employment, or
  • A disease or infection that naturally results from an accidental injury that arises out of and in the course of employment, including occupational disease and frostbite/sunstroke caused by a weather condition.
    • An occupational disease is defined as one contracted by a covered employee as the result of and in the course of their employment, and that causes the covered employee to become temporarily or permanently, partially, or totally incapacitated.

Further under Maryland law, the injury must:

  • Occur because of conditions required by the employer for doing the job, and
  • When the employee is doing the job.

Under the above definitions, an injured or ill worker will often be able to collect insurance for their workplace accident or occupational disease. However, this is not always the case.

Reasons for Denying a Workers’ Compensation Claim

Following are circumstances under which an employee may not be eligible for Workers’ Compensation insurance.

Preexisting medical conditions. You may not be able to collect Workers’ Compensation if your employer or its insurer determines that your injury was caused by an existing condition and not by the work itself. For example, if you have a history of arthritis in your right shoulder and your job involves lifting heavy boxes, a Workers’ Compensation claim for injury to your right shoulder may not be approved.

Personal risk. A Workers’ Compensation claim may be denied if you injure yourself at work or a worksite doing something unrelated to your job duties. For example, if you spill your thermos of hot coffee on yourself and suffer burns, that would be a personal risk and not a work-related risk. A Workers’ Compensation claim would not be approved.

Deviation from work. Even if an injury happened during the workday, it would not be covered if the employee deviated from work. For example, an employee decides to run a personal errand between meetings at work and is injured in a car accident. Workers’ Compensation would not cover those injuries because the errand was private and unrelated to their employment, even though it happened during a workday.

A deviation from work can also include something that happened in employment but was something a reasonable employee would never undertake. An example would be a construction worker who uses his own handmade but unsafe tool to get a job done. If the device injures the worker, a Workers’ Compensation claim would not be approved because any reasonable employee would not have used this unsafe, handmade tool.

Driving to and from work. Getting to or from the job is not considered within the course of employment; therefore, injuries would not be covered.

Intentional conduct. Sometimes workers will hurt themselves willfully or knowingly while on the job. For example, they may purposely ram their knee into something at work and claim they have been injured. Their Workers’ Compensation claim will most likely be denied. In addition, Workers’ Compensation claims are often rejected when an employee is injured while under the influence of alcohol or drugs.

Recreational or social activity. An employee could be denied Workers’ Compensation if they are injured while engaging in social or recreational activity while at work. For example, if the employer sponsors a health and wellness fair for employees and a worker is injured by exercise equipment. It could be challenging for the employee to be approved for Workers’ Compensation.

Illegal activity. If an employee is hurt while engaging in illegal activity at work, their injuries would not be covered. For example, suppose an employee sells drugs to another employee, and the two get into a fistfight with injuries. In that case, neither could claim Workers’ Compensation.

Terminated employees. Workers who have been laid off or terminated cannot file a Workers’ Compensation claim with that employer.

Horseplay. Injuries that happen while at work but while an employee is engaged in horseplay generally will not be eligible for a Workers’ Compensation claim. For example, if two warehouse employees are hurt while racing their forklifts against each other, a Workers’ Compensation claim generally will not be approved. However, innocent bystanders whom these two employees harm would most likely be able to collect Workers’ Compensation benefits.

Policy violations. Workers’ Compensation is not available to employees who are hurt on the job while violating company policies, protocols, or procedures. For example, if an employee in a chemical factory is injured from spilling toxic chemicals he was conveying improperly, his claim would most likely not be approved.

 Every situation is unique. A lawyer specializing in Workers’ Compensation and employment law could be a good resource if you have been hurt or fallen ill because of your job requirements.

How do I File for Workers’ Compensation?

In Maryland, employees must follow these steps to start a Workers’ Compensation claim:

  • Inform the employer about the injury, either orally or in writing, within 10 days of the injury. If an employee dies of the injury, the family must notify the employer within 30 days. If the employee develops an occupational illness, the employee or their family must inform the employer within one year from when the disease is discovered or the employee dies.
  • Employees who notify their employer in writing must state their name, address, time, place, nature, and cause of the injury. They must also sign the notification or have someone sign on their behalf. If the employee died of the injury, the notification must be signed by at least one of their dependents or by someone on their behalf.
  • The employee must file a claim form and a doctor’s report, if available. For most accidental injuries not resulting in death, employees must file a claim within 60 days of the incident. If there is a death, the employee’s family has 18 months to file. For an occupational disease, the injured employee or their family has two years to file, three years in the case of pulmonary dust disease.

An employer is obligated to file an accident report with the Maryland Workers’ Compensation Commission if an employee misses more than three days of work because of an accidental personal injury that causes a disability. They must file this report within 10 days of learning of the accident. In the case of occupational diseases, the employer must promptly report the disability to the Commission.

How are Workers’ Compensation Claims Decided?

An employee or employee can request a hearing to investigate their claim rather than simply wait for a decision. This hearing could involve medical examinations and witnesses to determine the severity of the injury. A member of the Workers’ Compensation Commission holds the hearing.

The Workers’ Compensation Commission will approve or deny a claim within 30 days of the mailing of the claim-filing notice or the hearing. If the employee or employer does not agree with the Commission’s decision, they can appeal to the circuit court. This appeal must be filed within 30 days of the mailing of the Commission’s order.

Baltimore Workers’ Compensation Lawyers at LeViness, Tolzman & Hamilton Fight for Employees Injured at Work

If you have been injured or fallen ill because of a workplace accident or occupational hazard, contact the Baltimore Workers’ Compensation lawyers at LeViness, Tolzman & Hamilton. We help injured workers get the compensation they deserve for damages, including medical bills, lost wages, and other expenses. Call us today at 844-556-4LAW (4529) or contact us online for a free consultation.

With offices in Baltimore, we serve clients throughout Maryland.