What’s Not Covered Under Pennsylvania Workers’ Comp

Generally, injuries and damages not covered by Pennsylvania workers’ compensation include injuries sustained outside the scope of employment, self-inflicted injuries, injuries caused by illegal activities or intoxication, injuries resulting from a direct violation of company policy, injuries to certain categories of workers, and pain and suffering. What does this really mean in practice? Here’s a more detailed breakdown:

1. Injuries Outside the Scope of Employment

Pennsylvania workers’ compensation only covers injuries that occur within the “course and scope of employment.” This generally means injuries sustained while performing work-related duties or tasks. It may include work events such as luncheons or parties, but every case is unique. If you believe your claim may be work-related, you should contact a lawyer for advice.

Examples of activities not considered work-related include personal errands, recreational activities, horseplay, or intentional acts unrelated to your job. If you are unsure whether your injury falls within the scope of employment, an experienced workers’ comp lawyer can help you determine if you have a claim.

2. Self-Inflicted Injuries

Workers’ compensation does not cover injuries that a worker intentionally causes to themselves. While this may sound straightforward, it is not always obvious. Pennsylvania workers’ compensation generally covers injuries or illnesses arising out of employment, but self-inflicted injuries are a key exception. This also includes injuries resulting from reckless behavior if the worker knowingly disregards safety rules or policies.

3. Injuries Due to Illegal Activities or Intoxication

Injuries resulting from an employee’s violation of the law, including the illegal use of drugs or alcohol, are typically not covered. This includes injuries caused by intoxication on the job.

For example: imagine you go out drinking late into the night and still feel intoxicated the next morning at work. While on the job, you fall off a ladder. If your employer can prove that intoxication caused the accident, your injuries will not be covered by workers’ compensation.

4. Injuries Resulting from a Violation of Company Policy or Work Orders

Injuries sustained while violating company rules or safety procedures may not be covered. For instance, starting a fight at work or blatantly ignoring safety protocols is unlikely to be considered a legitimate work-related injury under Pennsylvania law.

For example: if you initiate a fight with a co-worker and sustain injuries, your claim will likely be denied. On the other hand, if you were an innocent bystander who got hurt, if the fight was directly related to work, or if the employer tolerated horseplay, you may still have a valid claim. In these situations, you should consult with a lawyer to evaluate your case.

5. Injuries to Certain Workers

Not every worker is automatically covered by Pennsylvania workers’ compensation. Some categories include:

• Independent Contractors: Independent contractors are generally not covered. However, if you are misclassified as a contractor when you should be considered an employee, you may still be entitled to coverage. Subcontractors may also be considered “statutory employees,” making the hiring company responsible for providing workers’ compensation insurance.
• Federal Employees and Railroad Workers: These workers are covered under separate federal workers’ compensation systems.
• Sole Proprietors and General Partners: These individuals are often not required to carry workers’ comp coverage for themselves.
• Volunteers: Volunteer workers are typically not covered by workers’ compensation laws.

If you are an independent contractor or in another excluded category but were injured on the job, speak to an attorney right away to determine whether you may still have coverage.

6. Pain and Suffering

Workers’ compensation insurance does not provide benefits for pain and suffering. These damages—such as physical discomfort, emotional distress, and loss of quality of life—are considered non-economic and are not recoverable in a Pennsylvania workers’ compensation claim.

While work injuries often have a major impact on all aspects of life, workers’ comp benefits are designed to cover medical expenses and wage loss, not pain and suffering.

Talk to Stern & Cohen About Your Workers’ Comp Claim

If you are unsure whether your injury is covered under Pennsylvania workers’ compensation, the best step you can take is to consult with an attorney. At Stern & Cohen, our experienced Philadelphia workers’ comp lawyers can help you understand your rights, determine eligibility, and fight to secure the benefits you deserve.