Key Exclusions to Workers’ Comp That Every Employee Should Know
Connecticut workers’ compensation insurance can be a lifeline for injured employees. However, not every workplace injury or illness qualifies for coverage. When an unfortunate event occurs at work, knowing what’s not covered by workers’ comp in Connecticut is just as important as knowing what is. The workers’ compensation attorneys at Jacobs & Dow, LLC will help you understand common exclusions, when exceptions might apply, and when to seek experienced legal help.
Understanding Connecticut Workers’ Compensation
Connecticut’s workers’ compensation system is designed to provide medical care, wage replacement, and other benefits to employees who are hurt or become ill due to their job. That said, not every situation is protected. Many employees are surprised after filing a claim to learn their injury or illness is excluded from coverage.
1. Intentional Acts Excluded from Workers’ Compensation
Workers’ compensation in Connecticut is not meant to protect employees who intentionally harm themselves at work or purposely break the law. The reasoning is straightforward: Coverage exists for genuine workplace accidents, not for intentional bad acts. These include:
- Suicide or self-inflicted injuries are not covered by workers’ comp. If an employee intentionally harms themselves, they (or their family) cannot file a successful claim for those injuries.
- Injuries resulting from illegal activities are also denied. For example, if someone is injured while stealing property or engaging in unauthorized violence, these injuries are not covered by Connecticut workers’ comp.
Key takeaway: Injuries must be accidental and not the result of intentional misconduct or criminal action.
2. Injuries Due to Intoxication or Drug Use
Intoxication and illegal drug use are among the most common reasons for claim denial.
- Injuries sustained while under the influence will likely be denied by workers’ comp. This exclusion aims to discourage impaired work and keep the workplace safe.
- If your employer or insurer proves that intoxication was the primary cause of your injury, your workers’ comp coverage will be denied.
Example: If you slip and fall because you were intoxicated at work, your claim probably won’t be covered.
3. Injuries from Violating the Law
Some injuries occur during illegal acts, and these are generally not eligible for benefits.
- Any injury that happens during the commission of a crime or while violating company policy can result in claim denial.
- Examples might include being injured during theft, employment fraud, or acts of violence.
Note: If you were acting within the scope of your employment but unintentionally broke a minor policy, an exception may apply, but significant or criminal acts will effectively disqualify your claim.
4. Voluntary Participation in Recreational Activities
Many Connecticut employers offer parties, picnics, or sports days. But if you get hurt while volunteering for these activities, benefits usually aren’t available.
- Voluntary participation means you aren’t required to take part. If you’re injured during a baseball game, a holiday party, or a similar event, that injury typically isn’t covered.
- This holds true even if your employer contributes to the event’s costs.
- If your attendance or participation was required as a condition of employment, there may be grounds to argue for coverage. However, Connecticut law generally draws a sharp line regarding voluntary involvement.
Pro tip: Always check your employee handbook or event invitation to see if participation is mandatory.
5. Mental or Emotional Impairments
Mental health issues can be life-altering. Unfortunately, Connecticut’s workers’ compensation system generally excludes coverage for most mental or emotional injuries that aren’t tied to a physical incident.
- Mental health claims (like stress, anxiety, or depression) that cannot be proven to result from a work-related physical injury or occupational disease are not covered by workers’ comp.
- If a mental or emotional impairment arises directly from a physical workplace injury or a diagnosed occupational disease, it may be compensable.
- Additionally, some impairments resulting directly from a “personnel action” (transfer, promotion, demotion, or termination) are excluded, but there are important legal nuances to consider.
Example: Developing PTSD after a workplace accident may be covered if the trauma resulted from an actual, physical work event.
Additional Claims Typically Not Covered
While the exclusions above are the most common, Connecticut law includes further limitations you should know:
- Commute-Related Injuries: Injuries that happen on your way to or from work are generally not covered (the “coming and going” rule), unless you’re on a specific work-related errand.
- Personal Detours: Getting hurt while taking a personal side trip during work-related travel eliminates coverage.
- Non-Employees: Workers considered “casual,” those employed in private homes for less than 26 hours a week, or certain corporate officers may not be covered under Connecticut workers’ comp laws.
- Off-Duty Injuries: Injuries outside of work hours (not work-related) are not covered unless you were performing a work task at your employer’s request.
Keep these exceptions in mind to set realistic expectations about your claim.
Protect Your Rights: Know What’s Not Covered and Take Action
Understanding what’s not covered by workers’ comp in Connecticut helps set the right expectations and avoid unwelcome surprises after a workplace injury. While the state’s workers’ compensation system offers important protections, it does not provide a safety net for every situation.
If you believe your claim was wrongfully denied or your injury fits one of the complicated “gray areas” above, don’t hesitate to seek professional help. The attorneys at Jacobs & Dow, LLC are here to review your case, answer your questions, and work tirelessly to secure the compensation you deserve. Contact us today to schedule a free consultation.
