Serious accidents can happen anywhere, at any time. Still, according to the State of California Labor Code, specific injuries may not be covered by workers’ compensation, even if you are at work or doing another task that is work-related.
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The situations and rules described in this blog are by no means black and white; every case has specific details that differentiate it from the generic situations described here. If you have been severely hurt and believe you may have a workers’ compensation claim to pursue, especially if you are permanently disabled, call us. We have helped injured workers in California get the benefits they are rightfully owed for over 30 years.
What Injuries Are Not Covered by California Workers’ Compensation: The Basics
Here are four main types of injuries that are typically not covered by workers’ compensation:
- Injuries sustained while intoxicated or impaired due to drugs or alcohol
California Labor Code section 3600(a)(4) is clear: Injuries that are a direct result of intoxication are not eligible for compensation. However, there is a gray area, which is why you may want to get professional legal advice, especially if your injuries have resulted in permanent or long-term disability. The gray area is this: The employer must be able to prove that the employee’s intoxicated state contributed directly or was a primary factor causing the injury. In other words, simply being in an impaired state does not automatically disqualify you if the impaired state had no bearing on the cause of the accident.
Hypothetical scenario: A construction worker returns from lunch offsite. At lunch, he had one beer. As he is changing into his work boots in the employee-designated trailer that serves as the break area, a forklift operator onsite breaks a gas main, causing an explosion and collapsing the trailer. The employee, along with several others, is severely injured. In this scenario, it would be highly challenging, if not impossible, for the employer to successfully prove that the employee’s level of intoxication at the time of the explosion in any way contributed to his injuries.
- Injuries Caused by Fighting or Horseplay
Violence or horseplay leading to injuries is, in general, not covered by workers’ compensation. However, if it’s determined that the fighting was due to a specific work-related problem, or if the horseplay is a normal part of the work environment while performing one’s job duties, and has been allowed by the employer, there may be a path to compensation for the injuries.
Hypothetical Scenario: Two employees decide to arm-wrestle to determine who will operate the forklift for a warehouse graveyard shift. The employer knows that shift workers commonly decide work-related tasks amongst themselves in this manner. In the course of the arm-wrestling, one of the employees gets angry that he lost, and an angry brawl ensues, leading to a severe head injury for one of them. In this situation, a successful workers’ compensation benefits claim may be possible if arm-wrestling is an established part of work-related activities, even if it is informal or unofficial.
- Injuries Sustained Off-Site at a Work Event
Injuries incurred at things like holiday parties, company picnics, or team-building activities held away from the work site, regardless of industry, usually are not covered by workers’ compensation benefits. One exception to this general rule is whether the event is mandatory. If it is, workers’ compensation is likely to cover it. If the event is optional (and the employee is not paid for being there), it is doubtful for the injury to be covered by workers’ compensation benefits.
- Injuries Sustained While at Lunch or on a Break (Away from the Workplace)
This is another fairly straightforward rule about whether the employee was fulfilling work-related duties or not. Clocking out and going to lunch down the street from an office is not work-related. If an injury occurs, such as tripping and breaking an ankle at the restaurant entrance, it would not qualify for workers’ compensation benefits. (It could, however, result in a personal injury claim against the restaurant.) On the other hand, if the employer instructed the employee to go collect lunch for the office and bring it back, and during that excursion for that purpose became injured, a workers’ compensation claim could likely be filed successfully.
If you have been seriously injured at work or in a work-related activity and faced with the possibility of permanent or long-term disability, and have been denied benefits and want to appeal, or you aren’t sure whether your injury qualifies for workers’ compensation, call our office. We offer a free, no-obligation consultation to hear the facts of your situation and answer your questions. If we take your case you owe no fees unless and until you win.
Call Eason & Tambornini’s workers’ compensation attorneys in Sacramento today at (916) 438-1819 to schedule your free case review.