Workers’ compensation covers many work-related health problems, but it does not cover all injuries a worker might experience. In some situations, people cannot get these benefits. Knowing why this happens can help employees use the system better and stay safe.
The employee did not qualify for workers’ comp.
In Missouri, workers’ compensation usually helps employees hurt on the job. However, some workers might not have coverage. These include independent contractors, businesses that have fewer than five employees and many volunteers.
The injury happened outside of work duties.
If an employee gets hurt while doing something not part of their job, even at work, workers’ compensation may not cover the injury. This includes horseplay, personal errands or activities not allowed by the employer.
The worker did not report the injury quickly.
Reporting injuries on time is important. Employees are generally required to report injuries within 30 days of becoming injured or realizing that their work impacted their health. Failure to do so can result in denial of the claim.
The injury happened because the person broke company rules.
Workers’ compensation might not cover injuries from breaking company rules. These may include not wearing required safety gear or ignoring safety protocols.
The injury occurred while the employee was under the influence of drugs or alcohol.
If an injury occurs while the employee is using drugs or alcohol, the claim might be denied. Many employers require drug testing after an injury to check for substance abuse.
The injury was a pre-existing condition.
Workers’ compensation does not cover pre-existing conditions unless the work environment significantly aggravated the condition. Proving this can be challenging and often requires substantial medical evidence.
The worker committed fraud during their claim.
Workers’ compensation insurance will deny claims that involve fraud. This includes exaggerating an injury, claiming an injury that never occurred or falsifying details.
Understanding these exclusions and keeping potential issues in mind can empower employees and help them get the support they need from a workers’ compensation claim.