What Is Not Covered by Workers’ Comp in Pennsylvania?

If you are injured at work in Pennsylvania, you may be entitled to workers’ compensation benefits to cover medical bills and lost wages. However, not all injuries are covered under Pennsylvania’s Workers’ Compensation Act. There are clear rules about which injuries and situations qualify and which do not.

Below, we outline the most common types of injuries and circumstances that are not covered by Pennsylvania workers’ compensation.

1. Injuries That Happen Outside of Work

Workers’ compensation only covers injuries that occur while performing job-related duties. Injuries sustained outside of work are generally not covered.

Examples include:

• Tripping at home after work
• Getting in a car accident while commuting to work
• Twisting an ankle at a grocery store on the weekend

These are not covered because they did not occur in the course and scope of employment.

2. Self-Inflicted Injuries

If an employee intentionally injures themselves, those injuries are not compensable. Similarly, injuries caused by reckless behavior when the employee knowingly disregards risks may be excluded.

Examples include:

• Deliberately cutting yourself to try to miss work
• Starting a fight with a co-worker
• Engaging in reckless behavior solely for amusement

The law is designed to protect workers who are legitimately injured—not those who attempt to abuse the system.

3. Horseplay or Fooling Around

If an employee is injured while engaging in horseplay or unsafe behavior that violates company rules, benefits may be denied.

Examples include:

• Riding on a forklift as a joke and falling
• Running in restricted areas of a warehouse
• Climbing on unsafe structures against policy

Employers have a right to enforce safety rules, and violating them can jeopardize a claim.

4. Intoxication or Drug Use at Work

Injuries caused by intoxication or the use of illegal drugs are not typically covered. Employers or insurers may require a drug or alcohol test to confirm intoxication.

Example:

• Operating machinery while intoxicated and causing an accident

If intoxication is proven to be the cause, workers’ compensation benefits can be denied.

5. The “Coming and Going” Rule

Most injuries that occur while commuting to or from work are not covered under workers’ compensation. This is known as the “coming and going” rule.

Exceptions include:

• Driving a company vehicle to different job sites
• Running an errand at your employer’s request
• Traveling for work-related business

6. Illegal Activities or Criminal Conduct

Injuries sustained while committing an illegal act during work hours are not covered.

Examples include:

• Getting injured while stealing from your employer
• Sustaining injuries during illegal activity on the job

Employees must be engaged in lawful work activities to receive workers’ compensation benefits.

7. Pre-Existing Conditions Not Aggravated by Work

Workers’ compensation does not cover pre-existing medical conditions unless work duties directly aggravate or worsen the condition.

Example:

• A worker with chronic back pain unrelated to job duties may not qualify for benefits.
• However, if the condition is worsened by work tasks, benefits may be available with medical proof.

8. Common Illnesses

Ordinary illnesses such as colds, the flu, or allergies are not covered unless they are directly caused by workplace exposure.

Examples:

• Asthma caused by exposure to chemicals at work may be covered.
• Catching a cold from a co-worker is not.

9. Pain and Suffering

Pennsylvania workers’ compensation does not provide benefits for pain and suffering. Compensation is limited to medical expenses, wage-loss benefits, and, in some cases, specific loss or permanent disability benefits.

10. Certain Categories of Workers

Not all workers are eligible for Pennsylvania workers’ compensation.

Examples of excluded workers include:

• Federal employees (covered by federal systems)
• Railroad workers and longshoremen (covered under federal statutes)
• Independent contractors (unless misclassified)
• Volunteers or unpaid workers
• Some farm laborers
• Certain religious workers
• Business owners who opt out of coverage

If you are unsure whether you are covered, an attorney can review your situation.

11. Unnecessary or Unrelated Medical Treatment

Workers’ compensation only pays for medical care that is reasonable, necessary, and directly related to your work injury.

Examples of treatment not covered include:

• Daily chiropractic visits unrelated to your injury
• Experimental or unapproved treatments

Insurers may request an independent medical exam if treatment is questioned.

What to Do if Your Claim Is Denied

Receiving a denial letter is not the end of the process. You still have options.

Steps you should take include:

• Contacting a Pennsylvania workers’ compensation lawyer
• Keeping detailed records of your injury and medical visits
• Filing a claim petition with a workers’ compensation judge
• Continuing to attend medical appointments

Many denied claims can still result in benefits with the right legal support.

Final Thoughts

Pennsylvania workers’ compensation exists to protect employees injured on the job—but it does not apply in every circumstance. To qualify, you must be performing job-related duties, acting within the law, and following workplace policies.

If you are unsure whether your injury is covered, or if your claim has been denied, contact Stern & Cohen. Our experienced Philadelphia workers’ compensation lawyers can review your case, explain your rights, and fight to secure the benefits you deserve.