If you are seeking workers' compensation benefits, you’ll have to show that your injury or illness is work-related—or, in workers’ comp legalese, “arising out of employment and occurring during the course of employment” (AOE/COE). Usually, if you were doing something for the benefit of your employer, and you were injured or became ill as a result, then your injury or illness is work-related and you can receive benefits as long as you meet the other eligibility requirements.
The AOE/COE requirement may seem like a simple rule, but it can get tricky. Some common situations are covered below.
Usually, injuries that happen on an employee's lunch break are not considered work-related. For example, you probably can’t claim workers’ comp for spraining your ankle while walking to a deli to pick up your lunch (or lunch for your coworkers). But the injury might be covered if you were also picking up lunch for your boss.
If you were hurt while eating lunch on the company's premises (especially in an employee cafeteria or lunchroom), the injury will generally be considered work-related. But it probably won’t be covered if you were doing something during the lunch break that wasn’t allowed or fell within other exceptions to workers’ comp coverage. For instance, in a case where an employee was injured during one of her regular lunch-hour “power walks” on company grounds, a Connecticut court found that the injury was “incidental” to her employment but came within the exception in state law for voluntary recreational activities. (Brown v. United Technologies Corp., 963 A.2d 1072 (Conn. Ct. App. 2009)).
Many companies sponsor special events like parties, picnics, or baseball games. Injuries sustained at these events are usually considered work-related. But some states make an exception if the employer doesn’t expect employees to participate in the off-duty events.
Under what’s known as the “going and coming rule,” workers’ comp generally doesn’t cover injuries sustained during your commute to or from work. There are exceptions to this rule, however, including when you’re:
If you were injured while breaking a workplace safety rule or while doing something else that your employer has prohibited, your injury might still be covered by workers' comp, depending on the level of your misconduct and where you live. This is part of the workers' compensation bargain: Employees do not have the right to sue their employer for work-related injuries, but those injuries are usually covered by workers' comp, regardless of fault.
There are some exceptions to this general rule. Workers’ comp usually doesn’t cover injuries that happen because the employee was drunk or using illegal drugs. Several states also rule out workers’ comp coverage when the injured employees were:
However, courts may consider injuries involving rule-breaking or horseplay to be work-related if the employer knew about and condoned the behavior, or it was a common or accepted part of the working environment.
Workers’ comp may also cover cumulative injuries developed over time (such as repetitive strain or stress injuries or RSIs), occupational diseases and other illnesses resulting from long-term on-the-job exposure, and physical or psychological illnesses resulting from workplace stress. But in these cases, it may be difficult to prove that the injury or illness is work-related. The rules may also vary from state to state, especially when it comes to stress-related and emotional illnesses. To learn more, see Injuries and Illnesses Covered by Workers’ Compensation.
If your work aggravated or “lit up” a pre-existing condition, the aggravation will probably be considered a work-related injury.
If your injury or illness falls into a gray area for workers’ comp coverage, it would be a good idea to consult with an attorney to find out whether you might be eligible for benefits. An experienced workers’ comp lawyer can explain how your state’s laws apply to your particular situation. (To learn about your legal options if you aren’t eligible for workers’ comp, see When You Can Sue Outside of Workers' Compensation.)