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Know which ‘personal’ injuries qualify for workers’ comp

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in Compensation and Benefits,Human Resources

State law typically governs ­workers’ compensation rules, and most states clearly say that employees can only earn workers’ comp benefits if their injuries are due to the performance of their job duties.

That’s true for physical injuries (broken leg caused by slip on factory floor) as well as psychiatric problems caused by work-related issues. And injuries don’t have to occur on company premises.

Employees could be covered if injured while traveling on business or even attending a business-related social event.

Advice: Be on the lookout for em­­ployees who try to pass off personal injuries as being job-related. Chal­­lenge workers’ comp claims in such cases.

As two court rulings show, it’s not always clear what is a work-related injury.

Case 1: On-site, off-the-clock horseplay. During a lunch break, a Pennsylvania laborer and his supervisor were horsing around in the lunchroom. The supervisor jokingly grabbed the employee and slammed him onto a lunch table. The employee injured his back and filed for workers’ comp.

Citing the “personal animus” de­fense, the company argued that it wasn’t liable for one employee’s intentional harm of another. But the court sided with the employee, saying that, to escape liability, the employer must prove that the employee’s acts were intended to injure the claimant.

Case 2: Psychological “injury” from office gossip. After a school bus driver’s affair with a co-worker became hot gossip, the bus driver complained to her boss, who told everyone to put a lid on the rumors. Still, the driver filed a workers’ comp claim, saying she was diagnosed with depression and suffered a psychological injury from the hostile work environment.

A state workers’ comp board granted her claim, saying her co-workers were the source of the gossip. But her employer appealed and a court tossed out the claim, saying a psychological injury caused by gossip about an employee’s personal life isn’t related to her employment.

Final tip: In addition to nonwork-related injuries, workers’ comp coverage may also typically be denied in situations involving:

  • Injuries related to the employee’s intoxication or use of illegal drugs
  • Self-inflicted injuries
  • Injuries suffered while an em­­ployee commits a crime
  • Injuries suffered when an employee’s conduct violated company policy.

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