Can I Get Workers’ Compensation Benefits if I Was Injured at Lunch?
Ryan Zavodnick | March 5, 2020 | Workers' Compensation
Worker’s compensation is employer-paid insurance. The employee does not pay for coverage. The insurance covers injuries that an employee sustains if they are injured on the job. There are two main purposes of worker’s compensation. First, it is intended to help pay for medical bills and lost wages for an injured employee until they are able to work again. Second, it protects the employer from possible future lawsuits that could be filed by the employee.
Private company accidents are generally handled at the state level. However, there are other options if the employer is the federal government. For example, a federal employee who is injured at work or develops an occupational disease would be covered by the Department of Labor’s Office of Workers’ Compensation Programs (OWCP). These programs provide occupation therapy, lost wages, and medical treatment to qualifying federal employees and their dependents.
Worker’s Compensation in Pennsylvania
Most benefits are regulated and paid by state-run worker’s compensation funds or private insurance companies. Worker’s compensation in Pennsylvania is handled this way. The Pennsylvania Department of Labor and Industry handles all claims through the Bureau of Workers’ Compensation branch.
In Pennsylvania, an employer is required by law to purchase some form of worker’s compensation insurance. If they do not have insurance, they face fines and possible lawsuits. There are four ways that an employer can get coverage in the state:
- Obtain a worker’s compensation insurance policy through a private insurance agent or broker.
- Utilize the State’s list of insurance carriers who offer worker’s compensation insurance to companies located in Pennsylvania.
- Pay for insurance through the State Worker’s Insurance Fund. Private insurance companies might offer exaggerated rates or refuse to offer insurance to new companies because they lack a credit or work history. The main purpose of this fund is to make sure that new or expanding companies can get the coverage that is required by law.
- Apply to the State for self-insured status. This is available to large, financially-stable companies that have been operating for at least three years. This status allows a company to guarantee that it will pay for things covered under general worker’s compensation policies if an employee is injured while on the job.
Types of Injuries Covered by Worker’s Compensation
Worker’s compensation covers many work-related injuries. It can cover accidents like slip and falls or broken bones. It can also cover long-term injuries like chronic back pain or repetitive stress injuries. There is no time limit on how long benefits can be used. They are available to qualifying employees as long as they need them.
Location is not a deciding factor in whether you can apply for worker’s compensation benefits. Your injury must simply be job-related. For example, you would more than likely be covered if you are injured on a work trip away from your office. Additionally, someone who has a job where they are constantly on the road, like a mail delivery person, could get worker’s compensation for any injuries acquired while working their delivery route.
There are some injuries that are not covered by worker’s compensation. Generally, no benefits will be given if there is some sort of negligence on the part of the employee. An example of this would be an employee getting injured while operating machinery under the influence of alcohol or drugs. Other injuries that are typically denied include:
- Injuries suffered while the employee is committing a crime
- Injuries that occur when an employee breaks company regulations or safety rules
- Self-inflicted injuries
- Injuries that happen that do not happen while the employee is on the job
Can you get Worker’s Compensation Benefits for being injured at lunch?
As with most legal questions, the answer to this is- it depends. The Pennsylvania Workers’ Compensation Act, 77 P.S. §411(1) describes situations that may be covered by worker’s compensation. The most important qualification is that the injury must be related to the worker’s employment. This means that if you are taking lunch away from work with friends and get injured, you will probably not be able to get worker’s compensation.
However, Pennsylvania has generally found that if an employee is taking a lunch break on the premises of their work, they are considered still “in furtherance of the employer’s business”. This means that an injury in the break room is more than likely covered by worker’s compensation. Again, coverage will more than likely be denied though if there is negligence on the part of the employee or if the injury is clearly not work-related.