Some Injuries May Not Be Covered, Even if They Occurred on the Job

Full-time employees, temporary workers, and paid interns are all generally eligible for benefits as long as their injuries were incurred at work or while they were acting in the scope of their employment. Nearly all Pennsylvania employers must carry workers’ compensation insurance, either through a state-run insurance program, a private insurance company, or self-insured policy. The system was created in part to ease the burden of workers who would have otherwise had to prove their employer was negligent in order to recover compensation. In exchange, workers may not sue their employers in personal injury lawsuits; workers’ compensation is considered to be their “exclusive remedy”.

Although the system is no-fault, there are certain types of injuries that may not be covered by workers’ compensation insurance, including:

• Certain psychological injuries – Workers may be able to claim benefits for mental stress injuries, however, the mental injury must have either been caused by a work-related physical or psychological stimulus. Claims based on the mental/mental standard are typically more difficult to prove because the psychological injury must have been caused by either an extraordinary event or an abnormal working condition.
• Disfigurement or scars below the neck – The Pennsylvania Workers’ Compensation Act only grants benefits for scarring or disfigurement to the face and neck. Other parts of the body are currently not compensable.
• Injuries intentionally caused by employees – Generally, workers are entitled to compensation for their injuries regardless of who was at fault for the incident. However, workers who engage in willful misconduct or horseplay, as well as those who were under the influence of drugs or alcohol at the time of their injury and those who intentionally inflict injuries upon themselves, may not be eligible for coverage.
• Injuries suffered by certain types of employees – Federal employees, longshoremen, railroad employees, independent contractors, volunteers, and certain other types of workers are not covered by the Act. However, they may be entitled to compensation under other federal laws such as the Federal Employers’ Liability Act.
• Injuries sustained while commuting to or from work – The coming and going rule prohibits employees from collecting workers’ comp for injuries they sustain on their way to or from work. However, workers acting in furtherance of the business of their employers may be eligible for benefits even if their accident did not occur at a fixed workplace location.
• Non-economic damages – Pain and suffering, emotional distress, loss of consortium, decrease in quality of life, and other non-economic damages are not covered by workers’ compensation. However, these damages may be available in other types of lawsuits, such as third-party personal injury claims.
• Non-work-related injuries – Work injuries that occur outside of work are not covered by workers’ compensation. However, non-work-related pre-existing injuries may be covered under the Act if they were aggravated or worsened by the employee’s work activities or environment.