Am I Covered?

Generally speaking, if you are injured while at work, the injury is compensable and covered by the employers workers compensation insurance. This insurance covers medical bills, prescription costs and payment for time off of work. There are however, instances when a person is not covered, so what makes a compensable injury?

There are five elements to a compensable work injury. They are (1) the injured person must be an employee; (2) there must be an injury; (3) the employee must be engaged in work at the time of the injury; (4) the injury cannot have been self-inflicted; and (5) the injury must arise from the employment.

Determining whether an injured person is an employee is generally very simple. If engaged in performing services for another, generally an employment relationship exists. Wisconsin law sometimes include independent contractors under the umbrella of employees for purposes of workers compensation.

The injury prong is also generally very simple to determine. An employee is injured if he suffers “mental or physical harm to an employee caused by accident or disease.” Wis. Stat. § 102.01(2)(c). An injury can be incurred either by accident (a one-time occurrence) or disease (an injury related to long-time exposure).

The third prong becomes more difficult to distinguish. At the time of the injury, the employee must be engaged in work. This means that he must be performing a task relative to his job without having broken the employment relationship. A simpler way to explain this is to say that the worker cannot have “deviated”. Deviation is when an employee does something to further his own personal interests rather than the interests of the company. For example, horseplay, fights or ignoring a employer’s directive can be considered a deviation, thereby voiding an employee’s right to benefits. It is best to contact an attorney if there are any questions regarding this issue.

The fourth prong is again a straight forward test. If the employee cuts off his finger on purpose, no benefits are allowed. If the employee is injured intentionally, the employer is not liable.

Finally, the injury must arise out of employment. Essentially, the injury must have arisen from the natural course of work; in other words, it must be a natural hazard of the employment.

In most cases however, if the injured person was at work, performing his job in the regular manner and is unintentionally injured, the injury is compensable on its face. Any questions that arise regarding whether the injured worker is covered should be discussed with an attorney.

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