Have you been injured in an auto accident? You may be entitled to workers’ compensation benefits. This article will explain the circumstances under which workers’ compensation applies, from the office of a Workers’ Compensation Philadelphia, PA.
What is Workers’ Compensation?
Workers’ compensation is a no-fault insurance scheme mandated by state law for most employers. The purpose of workers’ compensation insurance is to:
- Compensate the injured employee for medical expenses and lost wages;
- Help the injured employee recover and get back to work;
- Keep personal injury lawsuits based on workplace accidents or conditions out of the court system;
- Preserve the employer-employee relationship.
An injured worker is compensated much more quickly than they would be if they have to sue their employer and wait for a money judgment or settlement.
Under workers’ compensation, an injured worker receives all medically-necessary treatment and is compensated at ⅔ of wages for the time at work lost due to the injury. If the worker cannot return to previous duties, they may be eligible for “light duties.” If a worker is temporarily or permanently partially or totally disabled, they may receive compensation for that based on the severity of the disability.
Who Can Get Workers’ Compensation Benefits?
An “employee” is entitled to workers’ compensation if they are injured or contract a disease or condition “in the course of employment.”
Who is an “Employee?”
An independent contractor, seasonal worker, day laborer, temporary worker, unpaid volunteer, or family member will not be entitled to workers’ compensation unless they can show they should be deemed an “employee” for the purposes of workers’ compensation. Courts ask the following questions to determine whether a worker is an employee:
- Does the employer control the details of the work?
- Does the worker have specialized knowledge, skill, or training?
- Is the worker engaged in a type of work that is independent of the employer’s type of work?
- Is the worker paid by the job or paid a salary or an hourly rate?
- Does the worker furnish his own tools?
- Does the employer make deductions for Social Security or unemployment insurance?
- Does the employer dictate the hours or days of work?
- Does the employer retain hiring and firing power, or does the worker have the right to finish a job?
What is considered “In the Course of Employment?”
If driving or being near cars or trucks and the like is within an employee’s regular work duties, and the employee is injured by one of those vehicles, that is considered being injured “in the course of employment” and the employee will be entitled to workers’ compensation benefits.
Common Reasons Workers’ Compensation Claims are denied for Auto Accidents
The Injured Worker is Not an Employee
If a bystander, vendor, or other party not considered an “employee” for the purposes of workers’ compensation is injured on a job site by a car or truck or was driving a company car or truck and was injured in an accident, they will not be covered under workers’ compensation. The employers’ premises liability insurance and/or commercial auto insurance may payout, however.
The Injured Worker Was Not Injured in the Course of Employment
There are several circumstances under which an employee injured in or by a company vehicle will not be covered under workers’ compensation.
Driving the Company Vehicle Not Part of Regular Work Duties
If an employee does not drive a company vehicle as part of his regular work duties, workers’ compensation will not apply if he is injured in or by one.
Driving the Company Vehicle Not Authorized
If the employer did not direct the employee to drive a company vehicle, and the employee operates a company vehicle and is injured, he will not be covered by workers’ compensation. However, if the employer knew the employee was operating a company vehicle without permission or authorization and did nothing about it, the employee may be covered.
Horseplay In or Near Company Vehicle or Other Vehicle on Jobsite
Horseplay or fooling around is not considered part of work duties. If an employee is fooling around in or near a company vehicle and is injured, he will not be covered by workers’ compensation. However, if the employer knew about habitual horseplay and did nothing to stop it, the injured employee may be covered.
Doing Something Illegal In or Near Company Vehicle
If an employee is engaged in an illegal act and is injured in or by a company vehicle, workers’ compensation will not apply.
For example, if an employee is driving a company vehicle while under the influence of drugs or alcohol, he will not be covered by workers’ compensation if he is injured in an accident. If an employee is speeding, tailgating, or engaged in some other motor vehicle infraction and is injured in an accident, he is likely not covered.
Similarly, if an employee is injured by a company vehicle while engaged in illegal activity, he is not covered by workers’ compensation. If he is fighting with another employee and fails to notice a company vehicle and is struck by it, he will not be covered.
Going on a “Frolic” in the Company Vehicle
If an employee is authorized to operate a company vehicle but uses it for his own purposes, without the employer knowing, and is injured in an accident, he will not be covered because he has gone on what the courts call a “frolic.”
For example, if an employee is a delivery driver operating a company vehicle, stops at a bar for lunch with friends for a couple of hours, and slips and falls getting into the vehicle, he will not be covered. But if that same employee stops briefly to use the restroom, get coffee, or pick up dry cleaning and is injured operating the company vehicle, that is merely a “detour” and he will be covered.
Can I Appeal if My Workers’ Compensation Claim Was Denied?
Yes. If your claim is initially denied and you feel you are entitled to workers’ compensation benefits, you can appeal to the workers’ compensation court in your jurisdiction. Don’t take no for an answer! Many compensable medical claims are initially denied or underpaid, especially those filed by injured workers themselves. Hiring an attorney will give you the best chance of having your workers’ compensation paid in full.
About the Author
Veronica Baxter is a legal assistant and blogger living and working in the great city of Philadelphia. She frequently works with Larry Pitt, a workers’ compensation lawyer in Philadelphia.