What Workplace Injuries Are Not Covered by Workers’ Comp?
Workers’ compensation laws and coverages vary from state to state, making it all the more crucial for injured employees to know where to turn after sustaining an injury on the job. In California, certain injuries aren't covered by workers' compensation. It's vital for injured workers to understand what types of injuries are included or exempt from workers’ comp coverage under state law.
After a workplace injury, it’s best to consult with an experienced workers’ comp attorney who can help you exercise your employee rights and make the most informed decisions for your health and well-being. Keep reading to learn more about workers’ comp exemptions in California.
Compensable Injuries under California Workers’ Comp
Workers’ compensation provides benefits to workers who have been injured or ill due to their work. California law requires employers to carry workers' compensation insurance coverage for employees in the event of on-the-job injuries.
To be considered compensatory under California workers’ comp, injuries must entail a physical or mental condition that occurred as a result of work-related activities. This includes injuries sustained suddenly, such as slip-and-fall accidents, as well as those that may develop over time, such as carpal tunnel syndrome. Workplace illnesses that develop from exposure to hazardous materials or conditions in the workplace are also generally covered by workers’ comp.
For an injury to be covered by workers' compensation in California, the employer must 1) have workers' compensation insurance; and 2) their injury must meet specific criteria, including:
- The injury occurred during the course of employment or while performing work-related duties;
- The injury resulted in a temporary or permanent disability, medical treatment, or lost wages; and
- The injury was reported to the employer within 30 days of the incident.
Filing a Claim for Workers' Compensation
If you were injured on the job in California, it’s imperative to notify your employer about the accident as soon as possible. Remember, employees in California have 30 days to give notice to the company if they wish to file a workers’ comp claim.
After notifying your employer, they should provide you with a workers’ comp claim form to be completed and submitted to the company’s insurance company. Workers’ comp claim forms must include the following information to be accepted:
- The date and time of the injury or illness
- The location where the injury or illness occurred
- A description of the injury or illness
- The name and contact information of any witnesses
- Medical treatment received and healthcare provider information
3 Injuries Not Covered by Workers’ Comp in California
While workers’ comp is intended to help harrowing employees, it’s no secret that workers' compensation benefits are designed to be limited. When it comes to workers’ comp in California, specific exclusionary circumstances can apply, so having a basic understanding of these exclusions prior to filing a workers’ comp claim can save injured Californians time, money, and stress.
Below are 3 types of injuries that aren’t generally covered by workers’ comp in the Golden State:
1. Certain psychological conditions
Workers' compensation law in California excludes coverage for certain psychological conditions, such as stress, anxiety, and depression, unless the worker can prove that the condition was directly caused by a workplace injury.
For example, if an employee suffers from depression due to a work-related injury that led to physical harm, the resulting depression may be eligible for workers' compensation under California law. However, if an employee is suffering from depression due to non-work-related issues—such as hardships in their personal relationships or unrelated health issues—this probably isn’t a compensatory injury under state workers’ comp laws.
2. Injuries that happen during lunch breaks
In California, injuries sustained during lunch breaks are generally considered "off-duty" injuries. Consequently, injuries sustained during meals aren’t usually covered by workers' comp. However, there can be certain exceptions to this rule, such as:
- The injury occurred during a rest break, not a meal break – If the injury occurred while eating during a rest break instead of a lunch or meal break, it may still be covered by workers’ comp.
- The injury occurred on or near company premises – If an employee was injured on or near company premises during a meal break, there’s a higher chance that their injury will be covered by workers’ comp.
- The injury occurred during a “working” lunch – If an employee isn’t permitted to clock out for meal breaks and is injured during lunch while performing work-related duties, there’s a chance they can still receive workers’ comp benefits.
While lunch break injuries aren’t generally covered by workers’ compensation, employees may still be eligible for workers’ compensation if a work-related obligation spills over into their meal time.
3. Injuries caused by horseplay or employee misconduct
Injuries that result from engaging in horseplay or intentional acts of employee misconduct are generally not covered under California workers' compensation. For example, if an arm-wrestling match results in injury in the company breakroom, the injury is unlikely to be covered by workers' comp. Similarly, if an employee is injured because they were intoxicated on the job, they're unlikely to receive workers' comp as a result.
Over 15 Years Advocating on Behalf of Injured Workers
At Alvandi Law Group, our passionate workers’ comp attorneys have successfully recovered over half a billion dollars on behalf of hardworking California employees. We understand how terrifying it can be to sustain an injury at work. Many workers are understandably concerned about their financial security, health, and overall well-being after a workplace accident. Fortunately, our firm has the in-depth knowledge of state and federal workers’ comp laws to represent your best interests in court.
When you partner with our Orange County workers’ comp lawyers, you can expect us to fight tirelessly to recover the compensation you rightfully deserve. We have extensive experience advocating on behalf of wronged workers in a variety of workers' comp cases, from construction accidents to machine malfunctions. No matter your situation, you can expect our exceptional legal team to prioritize your needs from start to finish.
Injured on the job? Our workers’ comp lawyers can fight for the compensation you rightfully deserve. Call (800) 980-6905 to schedule a free consultation.