What Injuries and Circumstances Are Not Covered under Workers’ Comp?

Don Kamb
Workers' Compensation

Workplace injuries can result in medical bills and time away from work, leading to lost wages. Workers’ compensation (or “workers’ comp”) insurance can cover lost wages and medical bills due to an injury at work.

However, workers’ comp doesn’t apply to every injury and every circumstance. Certain events, employers, and individuals are not covered under workers’ comp. In this guide, we’ll explore what injuries and circumstances are not covered under workers’ comp and provide some next steps if you’ve been injured on the job.

Injuries Not Covered by Workers’ Comp

  • Minor Injuries: Workers’ compensation can reimburse employees for medical expenses and lost wages, but not for pain and suffering. This means minor injuries that don’t result in medical expenses or time away from work—injuries like minor scrapes and burns—are not covered under workers’ comp.
  • Unreported Injuries: Unreported—and undocumented—injuries may not be covered under workers’ comp. Each state has its own time limit for reporting injuries at work—for workers comp in South Carolina employees have 90 days to report an injury, compared to a maximum of 180 days in Utah and only 3 days or “as soon as possible” in many other states.
  • Injuries Arising from Disease or Preexisting Conditions: If you have to miss work due to a cold or flu, workers’ comp will likely not cover your lost wages—even if you suspect you caught the illness at work. So-called “diseases of life” that you might catch anywhere are generally not covered under workers’ comp. Similarly, injuries arising solely from preexisting conditions are not covered under workers’ comp, possibly including such things as heart attacks.
  • Injuries Outside of Work: Workers’ comp only covers injuries that happen at work. That means injuries that happen on your days off, during your commute, on lunch breaks, and at company-sponsored recreational activities may not be covered under workers’ comp, though there are exceptions.
  • Intoxication and Criminal Activity: Injuries caused by intoxication are not covered under workers’ comp, nor are injuries resulting from criminal activity, roughhousing, or fights at work–though again, there are exceptions.

What Is Not Covered by Workers’ Comp

Not all types of injuries are covered under workers’ comp, but even covered injuries may not be covered under every circumstance.

Employees Excluded from Workers’ Comp

Some types of employees are not eligible for workers’ comp coverage:

  • Business Owners: Business owners are generally required to carry workers’ compensation insurance on their employees, but many policies exclude the business owner unless the owner specifically opts to be included.
  • Independent Contractors: While independent contractors may share job duties and workspaces with employees, the companies they contract with are not necessarily obligated to carry workers’ comp coverage on their behalf. However, contractors can still purchase independent coverage from commercial providers and may be required to in some circumstances. And in some cases, the employees of independent contractors might be covered under the general or “upstream” contractor.
  • Industry-Specific Employees: Some industries are exempt from workers’ comp because they have an industry-specific alternative. For example, federal employees like postal workers have the Federal Employees Compensation Act while dockworkers have the Longshore and Harbor Workers’ Compensation Act that excludes them from workers’ comp requirements.

Types of Employers Excluded from Workers Comp

  • Small Businesses and Self-Employers: In South Carolina, businesses with four or more employees must carry workers’ compensation insurance, whereas businesses with less than four employees or less than $3,000 in annual payroll are not subject to that requirement. Self-employed individuals—just like business owners—aren’t required to have worker’s comp insurance for themselves, though it is still possible to opt-in or obtain such coverage.
  • Non-Profits and Volunteer Organizations:  These organizations may not be required to carry workers’ comp insurance coverage, but injuries that occur at a non-profit or volunteer organization may still be covered by another type of insurance.

Navigating an Injury at Work

If you’ve experienced an injury at work, always report and document the injury with the employer as soon as possible. This helps ensure you don’t miss out on a claim because of a technicality, and more importantly, allows your employer to address the cause of the injury and provide medical care.

If you’ve been hurt on the job, contact us for a free consultation. Our dedicated team of experts has the passion and experience to take the mystery and stress out of filing a workers’ comp claim. Schedule your free consultation with Williams & Kamb today.