The Gray Areas of Workers’ Compensation

If you are injured at work, you will more than likely be covered by Florida’s workers’ compensation.

Workers’ Comp, as it sometimes shortened, is a form of insurance that provides wage replacement and medical benefits to employees who are injured while at work. In exchange for these benefits, employees relinquish their right to sue their employer for negligence.

The key word in the above paragraph is, “injured while at work.” But sometimes, what constitutes “at work” can fall into a gray area.

Are you covered during your lunch period? At a company picnic? What about while commuting to and from work? This article will answer these questions while also providing insight into some other gray areas of workers’ comp.

A Couple Things to Keep in Mind

The first is the word compensable. Compensable means “able to be compensated.” For our purposes, the term implies that a situation would be covered by insurance. We will use “not compensable” to negate the idea.

When considering whether or not an injury is compensable under workers’ comp, two things are often kept in mind: deviation and distance.

Deviation references how close to or far from a certain activity is in relation to the job being performed. In other words, if a break is supposed to be 10 minutes, but someone is gone for 40 minutes, they strongly deviated from the break period.

The second concept is distance. Meaning, how far away was the employee when they were injured. Were they in the parking lot, on the sidewalk in front of the building, or down the street at a store? This is an important factor when determining compensability.

Understanding these three concepts will help to better understand the following content.

[For the sake of clarity, a ‘work injury‘ could include an illness or disease caused at or by one’s employment.]

Lunch Period

For the most part, injuries that happen during an employee’s lunch period are not covered by workers’ compensation. This is because you’re considered to be ‘on your own time’ during a lunch break.

For example, if you fell and broke your arm while walking into a local sub shop to pick up your lunch, you would not be covered. Likewise, if you were picking up lunch for yourself and your coworkers, then you would not be covered either.

The area becomes a little grayer if you were also picking up lunch for your boss. This would be considered a work duty (even you aren’t being paid for the time). If this the case, then the injury might be covered.

Short Breaks

Generally, accidents that happen during paid breaks are considered compensable. A big factor in this reasoning is the duration of the event. Likewise, the courts consider the employer‘s control over the employee to be an important factor. If you are at work, on a break that is required by law, then any injuries that happen on that break would be covered.

The employer also has ‘control’ over an employee while on a short break. They could pop their head out the back door and tell you to come answer a call or ask you while you are walking through the store to take a shopping cart up to the front as you head that way.

Even short breaks that occur off the premises would be considered compensable. This is not given, however, and would be determined on a case-by-case basis.

In the case, City of Miami v. Dwight, the court stated, “If the employer, in all the circumstances, including duration, shortness of off-premises distance, and limitations on off-premises activity during the interval can be deemed to have retained authority over the employee, the off-premises injury may be found to be within the course of employment.”

Work or Company Events

Lots of bigger companies and even small private owned businesses host different events throughout the year. This could include parties, company picnics, or charity softball games. Although the area is, of course gray, most injuries sustained at these events would be covered by workers’ compensation.

For example, if an employee is getting food during the company’s annual holiday party, and then trips while carrying the plate up the stairs, their injury would most likely be covered. This is because the employer expects employees to come to the gathering. (If they didn’t expect anyone to show up, they wouldn’t have the party). Since you would not attend the party if you did not work there, your injury is considered compensable. This is most likely the case, even if employees aren’t being paid to attend the function.

Travel and Commute

If you are injured on your daily commute to or from work, your injury isn’t covered by workers’ compensation. Basically, a line has to be drawn something.

It would be easy to say, “well if I didn’t have to come to work, I wouldn’t have been driving at that time in rush-hour traffic and therefore wouldn’t have been injured.”

But if this logic was used, there would be no end in sight. Then you could say that you wouldn’t have been burned by the curling iron if you didn’t have to get ready for work. Or you wouldn’t have been at the mall if you didn’t need to buy work clothes.

As you can see, the line must be drawn somewhere. For this reason, it’s most drawn by saying it must be on premises, during work hours, or during a task specifically for the benefit of the company.

If you are traveling specifically for work, as in to meet a client, then your injury would be covered. For example, if you are on a business trip to entice a new client, then your injuries would most likely be covered. If you travel as your primary work function, say as a delivery person with no regular work site, then any injuries you sustain while driving to deliver a package will probably be covered. This would also be true if you were not traveling at the exact time, say if you were bitten by a dog while taking the package to the front door.

The only common exception to the non-compensable commute involves a company vehicle. If you are injured during your regular, everyday commute, but are specifically driving a company vehicle, then your injuries will probably be covered.

Misconduct or Wrongdoing

If you were injured while engaging in workplace misconduct, your injury is probably covered. Although this is counterintuitive, it falls under the agreement discussed in the beginning of the article. Basically, injuries are covered regardless of fault.

This means that if you are injured while breaking one of your work’s safety rules, or while doing anything else that is considered ‘not allowed’ (like running in the hallways), you would still be covered. You would even be covered if you were injured while committing a criminal act at work.

This does, however—and hence the ‘gray’ part of the title—depend greatly on the level of the misconduct or wrongdoing.

Let’s take John, an employee working at a big box store, as an example. Every day, John is required to climb ladders in the stockroom in order to scan the store’s product. John knows that he is supposed to lock the ladder in place before climbing and always keep three points of contact with the ladder. In an effort to hurry things along, John never locks the ladder. He hasn’t in months. He is also required to scan items that sometimes must be picked up and turned around to find the barcode. This requires John to take both hands off the ladder to his job. One day, while scanning a big box, he loses his balance. As he clambers to get a grip, the ladder begins to fold up. It collapses and gives John a serious traumatic brain injury and spinal injury.

This would be covered for a few reasons. One, John’s employers should have understood that it is very hard to keep three points of contact while scanning large items. Second, he has been doing it long enough that someone should have noticed and corrected his behavior. And finally, the workers’ comp laws say that employees are covered regardless of fault.

This is not always the case, but for the most part, the fault is not taken into account. There are some gray(er) areas, like if an employee purposefully harms themselves, for example.

Preexisting Conditions

If you have a preexisting condition, it is obviously not covered by your employer’s workers’ compensation insurance. However, if you have a preexisting condition and your job aggravates or makes it worse, then the injury will most likely be considered compensable.

For example, Juanita had a herniated disc from a trampoline accident when she was a teenager. It has since healed. One day, while lifting a box of printer paper at the office, she feels a sharp pain. Her disc herniated again. This injury would be covered. Although lifting the paper did not cause the original injury,

Injuries the Occur over Period of Time

Most people do not consider injuries that happen over time when thinking about work-related injuries, but they are common. For example, people get carpal tunnel from working on assembly lines or injured backs from bending to lift a crank repeatedly for years.

Another common injury is hearing loss. Some people work in a very loud environment, like in factories or on airport runways. Although earplugs are often required, hearing loss does happen. In these instances, the injuries would be covered.

If it can be proven that something else caused the injury, like the person’s love for tennis causing carpal tunnel, then it may not be compensable.

Mental Conditions

Another commonly overlooked type of injury is those that are not physical. Mental conditions that are caused by someone’s job are often covered by workers’ compensation.

For example, if an employee is traumatized by seeing a coworker crushed by a machine, their psychiatric injuries would be covered. Likewise, if someone was criticized and harassed at work to the point of needing therapy, it would be covered. Some conditions related to being over-worked or over-stressed may even be covered.

Additionally, depression caused by a work injury that has completely changed your life may be covered by workers’ comp.

The gray area is large in mental illness cases, however. Unlike a broken arm, the mental illness can be hard to prove, much less if occurred at or because of work.

Diseases and Illnesses

As discussed before, injuries are not the only thing covered by workers’ compensation. Disease and illness are often covered too.

One of the most famous examples of a work-related disease is mesothelioma, which is caused by exposure to asbestos. Although cases are less common today, people still develop cancer because of the compound. People who work in coal mines often suffer from a condition called black lung disease, which is caused by inhaling coal dust.

However, these are pretty obvious examples. Other diseases and illnesses are not as easy to prove that they were directly caused at or by their work

[Click here to read about common workers’ comp myths.]