Are there any injuries that are not covered under Workers Compensation?

Workers compensation insurance was created to assist employees who have been injured in the course and scope of their employment, and require that work related injury was more than 50 percent of the cause that was responsible for the injury as compared to all other causes combined for which treatment or benefits are sought. As a general rule, workers compensation is a no fault statute, meaning, with few exceptions, who caused the injury is not critical in the ability for an injured worker to get benefits for that injury. Having said that, there are certain circumstances surrounding an injury that could take it outside of the protections and benefits workers compensation may provide.

As a general rule, workers compensation will not provide benefits for an injury that is based upon a mental or nervous injury due to stress, fright, or excitement alone. In order to receive any compensation for mental or nervous injuries, not only does the extent of the mental or nervous injury be proven, but it must be demonstrated that the cause of the mental or nervous injury was based upon an actual physical trauma.

Workers compensation does not recognize a work related condition that causes an employee to have fear or dislike for another individual because of the individual’s race, color, religion, sex, national origin, age, or handicap as a compensable work related injury and will not provide benefits for that type of claim.

No state, including Florida, will award benefits for “pain and suffering” that the employee sustains as a result of an industrial accident.

Compensation will not be paid if the injury is caused by the employee’s own willful intention to injure or kill himself or another.

No workers compensation benefits are available to an employee if the injury is caused primarily because the employee was intoxicated or under the influence of illegal drugs.

The employer is not responsible for care to an injured employee if the injury or death of the employee is covered by the Federal Employer’s Liability Act, the Longshore and Harbor Workers’ Compensation Act, or the Jones Act (if the injured worker is a “seaman” or member of a crew).

Benefits will not be made available if the disability or death is due to the accidental acceleration or aggravation of a venereal disease or of a disease due to the habitual use of alcohol or controlled substances or narcotic drugs If a preexisting disease or anomaly is accelerated or aggravated by an accident arising out of and in the course of employment, only acceleration of death or acceleration or aggravation of the preexisting condition reasonably attributable to the accident is compensable, with respect to any compensation otherwise payable under this chapter. An injury or disease caused by exposure to a toxic substance, including, but not limited to, fungus or mold, is not an injury by accident arising out of the employment unless there is clear and convincing evidence establishing that exposure to the specific substance involved, at the levels to which the employee was exposed, can cause the injury or disease sustained by the employee.

Do you have questions concerning whether an injury you suffered while working is compensable? You need the advice and guidance of a qualified, experienced attorney to help you receive all the benefits you may deserve and to maximize any recovery you may be entitled to. You need the help of Dan Newlin. In one free phone call, Dan can answer all your questions