When your employer’s insurance company investigates a workers’ compensation claim, the adjuster will determine whether the injury occurred during your normal course and scope of employment. This means that you were not only injured while at work but that you were acting within the range of your duties to further the employer’s business interests when the injury happened.
Learn more about how scope of employment may impact your workers’ comp claim.
If you became injured outside work hours while attending a social event sponsored and encouraged by your employer, you are still eligible for workers’ compensation. The law considers such morale-boosting activities as within the course and scope of employment because they further the company’s interest by creating an engaged, productive workforce. For example, if you slip and fall at the annual holiday party, the injury would fall under workers’ comp insurance.
Deviation from employment
If the injury occurs when you leave the workplace during the day for your own benefit, these actions fall outside the course and scope of employment. For example, if you decided to go shopping on your designated lunch break and got in a car accident on the way to the mall, your employer’s workers’ compensation policy would not cover sustained injuries. By the same token, injuries that happen on the way to or from work but off company premises do not qualify.
Horseplay and assault
Employees who become injured while playfully wrestling with one another or while otherwise engaged in horseplay will not qualify for workers’ compensation benefits. If your injury occurred when a colleague or customer intentionally attacked you, workers’ comp only comes into play if the reason for the attack was work-related.
If the insurance company denies your workers’ comp claim because of scope of employment, you have the right to appeal your case. The burden of proof is on the employer to show that your activities did not happen during the usual course of business.