Workers' Compensation
Written by: Bruce L. Weider | 5.28.2024

What Does Workers Compensation NOT Cover?

Are you wondering what does workers' compensation not cover in Michigan? While this insurance typically provides coverage for work-related injuries and illnesses, there are specific situations where benefits may not apply. Illegal activities, intoxication, horseplay, and self-inflicted injuries are among the instances not covered by workers' compensation in the state. In addition to the common exclusions mentioned, certain job positions, like railroad employees, fall under different regulations when it comes to workplace injuries. Understanding these exceptions is crucial for employees to navigate the complexities of workers' compensation coverage effectively. If you have other questions related to workers’ compensation or are struggling to get benefits you believe you are entitled to, consider calling Bruce L. Weider, PC at (734) 485-0535 to learn more about your legal rights from an experienced workers’ compensation attorney. 

Workers' Compensation Insurance: What Is Covered and What Is Not?

Workers' compensation insurance in Michigan provides crucial benefits to employees who suffer work-related injuries or illnesses. However, certain situations and circumstances are not covered under workers' compensation

What Is Covered?

Employees injured at the workplace while performing their job duties are typically covered. If the injuries are not from intentional self-harm or harm resulting from drug or alcohol use or fighting, they are usually covered. Injuries caused by repetitive work activities, such as back strain or carpal tunnel syndrome from constant gripping and grasping, are also included. 

What Is Not Covered?

While most workplace injuries or illnesses are covered, there are some instances when they will not be. Some cases where a workplace injury or disease will not be covered include: 

  • Injuries resulting from intoxication or substance abuse at work
  • Employees engaged in illegal activities or behavior at the time of the injury 
  • Injuries sustained due to horseplay or intentional self-harm 
  • Injuries resulting from failing to follow a strictly enforced rule (such as a back injury for lifting an item without the use of the required lift assist)
  • Injuries sustained as a result of social or recreational activities (such as playing volleyball at a mandatory company picnic)
  • Certain positions, like railroad employees, fall under the Federal Employers Liability Act instead of traditional workers' compensation

Workers' compensation insurance plays a critical role in protecting employees and businesses. By understanding what coverage includes and excludes, individuals can navigate the Michigan workers' compensation system more clearly and confidently.

Statute of Limitations for Workers’ Compensation Claims in Michigan

In Michigan, the statute of limitations for workers' compensation claims is crucial to understand. Employees must know they have a limited time frame to file a claim for work-related injuries or illnesses to be eligible for benefits. Failure to adhere to this deadline may result in a denial of benefits. The statute of limitations protects both employees and employers. This statute provides a clear timeline within which claims must be filed, preventing delayed or unfair claims from disrupting the workers' compensation process.

Per Michigan §418.381, the statute of limitations for filing a workers' compensation claim is within two years from the date of the work-related injury or illness. Employees should also be aware that certain exceptions to the statute of limitations may apply based on individual circumstances or the type of injury sustained. Consulting with a legal professional like Bruce L. Weider, PC, who specializes in workers' compensation claims, can provide valuable insights into their specific situation and ensure they meet all necessary deadlines.

When Coverage Begins for the Injured Employee

When an employee is injured at work, their medical bills are paid beginning with the first visit to a healthcare professional. Medical bills include any tests, imaging, prescriptions or other treatments ordered by the treating doctor. Rehabilitation expenses and disability benefits are also paid when the injury or illness requires them.

Compensation for lost wages is handled differently. How long the injured employee is out of work determines how they are compensated for lost wages: 

  • Out of work seven days or less: There is no lost wages compensation; medical expenses are the only compensation. The employee can use sick or other leave to cover lost wages if they have the time available and want to use it for this purpose. 
  • Out of work for eight to 14 days: Medical expenses are covered from the time of injury, and lost wages are paid at two-thirds of the employee’s average weekly wages from day eight through day 14. The employee is free to use sick or other leave for lost wages for the first seven days if they wish. 
  • Out of work 15 days or more: Medical expenses are covered from the time of injury, and lost wages are paid at two-thirds of the employee’s average weekly wages. Payment for lost wages is retroactive to the first day out of work. 

How Workers' Comp Defines a Covered Injury

What does workers’ compensation not cover? Michigan's workers' compensation system covers injuries that arise out of and in the course of employment. Understanding how covered injuries are defined is crucial for understanding what is covered or not covered. Here are some key points to consider:

  • Course of Employment: Covered injuries must occur while the employee actively engages in work duties or activities that benefit the employer. Injuries sustained during breaks, lunch hours, or while attending work-related events are generally not covered.
  • Arising out of Employment: Injuries must clearly connect to work activities or responsibilities. This includes accidents that happen on company premises or while performing job-related tasks.
  • No-Fault System: Workers' compensation is a no-fault system, meaning that employees are typically eligible for benefits regardless of who caused the injury. However, injuries resulting from intentional self-harm or misconduct are generally not covered.
  • Exceptions: Coverage does have certain exceptions, such as injuries sustained during personal errands, commuting accidents (with some exceptions), and injuries resulting from intentional acts that are not job-related.
  • Scope of Coverage: Workers' compensation typically covers medical expenses, lost wages, rehabilitation costs, and disability benefits for eligible injuries. Understanding the scope of coverage is essential for both employees and employers to ensure compliance with Michigan's workers' compensation laws.

Frequently Asked Questions

What injuries are covered under Michigan's workers' compensation system?

Michigan's workers' compensation system covers injuries that arise out of and in the course of employment. However, horseplay, social or recreational activities, breaks, intentional self-harm or misconduct injuries are generally not covered.

What benefits are typically covered by Michigan's workers' compensation system?

Michigan's workers' compensation system typically covers medical expenses, rehabilitation costs, lost wages, and disability benefits for eligible injuries sustained during employment.

What should employees understand about Michigan's workers' compensation laws?

Employees should understand the definitions of covered injuries and exceptions in Michigan's workers' compensation laws to ensure compliance and make informed decisions during the claims process.

Speaking to a Workers’ Compensation Lawyer About Coverage

Consulting a workers' compensation lawyer can clarify the answer to the question, what does workers’ compensation not cover? Nuances in individual cases may impact coverage. A lawyer can navigate complexities, assess eligibility, and effectively guide injured employees through the claims process. By seeking legal advice, individuals may be able to ensure their rights are protected and receive the support they deserve in case of work-related injuries. Consider partnering with a knowledgeable workers’ compensation attorney like Bruce L. Weider, PC by calling (734) 485-0535 to assist you in protecting your rights.

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Get the compensation you deserve

If you are in need of a workers' compensation attorney, contact us today. We have a track record of success in helping injured workers obtain the compensation they deserve. We understand the challenges that injured workers face, and we are dedicated to providing compassionate and effective legal representation from start to finish.

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