What types of injuries are not covered under Ohio Workers Compensation?

by The Bainbridge Firm, LLC | Sep 21, 2022 | Workers' Compensation

It is well established that the Ohio Workers’ Compensation system is not meant to act as a general insurance provider for every possible injury that could stem from employment. In fact, the law of Ohio has set forth specific parameters for what is, and is not, covered through Ohio Workers’ Compensation, lawyer or no.

What is a Workers’ Compensation-Eligible Injury?

The Ohio legislature has defined an injury for workers’ compensation purposes as “any injury, whether caused by external accidental means or accidental in character and result, received in the course of, and arising out of, the injured employee’s employment.”

Essentially, this definition provides that all work injuries, regardless of fault, are compensable so long as the injuries were received in the course of employment and arose out of the employment. This forms the basis of what a workers’ compensation lawyer in Ohio would argue about a typical case – that an injury falls under those conditions. But how are those conditions defined?

How Workers’ Compensation Attorneys and Courts Define “Course of Employment”

The “course of employment” element examines the time, place, and circumstances of an injury. The scope of the “course of employment” element includes activities that are consistent with the contract of hire and logically related to the employer’s business.

In other words, the course of employment consideration requires that in order for an injury to be covered it must have been incurred while the employee was actually doing something required by their job. If the injury occurs while an individual is on the job but doing something wholly unrelated to their employment, the injury is typically not compensable. This consideration leaves a lot to interpretation, and is something a workers’ compensation attorney will discuss with clients at length to ensure  they are being represented properly.

How Workers’ Compensation Attorneys and Courts Define “Arising From Employment”

The “arising from employment” element examines whether a causal connection exists between the injury suffered and the individual’s employment.

Analysis of this prong by an Ohio workers’ compensation attorney requires an examination of the totality of the circumstances including:

1) how close the accident was to an individual’s workplace

2) how much control an employer had over the scene of the accident, and

3) the benefit the employer received from the injured employee’s presence at the scene of the accident.

The “arising from employment” consideration often eliminates coverage for injuries that are incurred while doing activities that are incidental to and logically related to employment but are so disconnected from the job that coverage would be improper.

For example, when workers must drive to work in the morning, that is an activity that is incidental to and logically related to their employment. However, if they are injured in the course of that commute typically, with few exceptions, they are not entitled to coverage for injuries suffered while getting to work. Employers have no control over public roads and typically injuries suffered while commuting are not in close proximity to the place of employment.

So the “in the course of” and the “arising out of” considerations greatly limit what is and is not covered by Ohio Workers’ Compensation, with attorney or without.

Legal Limits to What What Workers’ Compensation Covers in Ohio

In addition to defining what is a compensable injury, the Ohio Revised Code provides a definition of injuries that are specifically not covered under the law. Our Ohio workers’ compensation lawyers understand these provisions very well and will help clients navigate them in their claim.

First, psychiatric conditions are not covered unless those conditions are found to be the result of a physical injury suffered on the job or is the result of sexual conduct in which the claimant was forced by threat of physical harm to engage or participate.

Second, an injury or disability caused primarily by the natural deterioration of tissue, an organ, or part of the body is not covered under the law.

Third, an injury incurred in the course of voluntary participation in an employer-sponsored recreation or fitness activity is typically not covered. However, this is only true if the employee signs a waiver of the employee’s right to compensation or benefits prior to engaging in the recreation or fitness activity.

Fourth, a condition that pre-existed a workplace accident is not compensable unless that pre-existing condition is substantially aggravated by the workplace accident.

Lastly, self-inflicted injuries, such as someone intentionally cutting themselves, are typically not covered.

Injuries that are the result of workplace fights, assaults, or horseplay are compensable when (1) the origin of the assault is work-related and (2) the injured worker was not the instigator. So if an injury comes from a fight at work, that injury will only be covered if the fight started over an issue that is work-related and the injured worker did not actually start the fight.

Again, some of these definitions can be argued in terms of whether they were closely related to the job or not. An employer’s lawyer will undoubtedly argue that an individual’s actions are not covered, and an Ohio workers’ compensation attorney would argue that they are. So even though these conditions seem straightforward, there is often an argument to be made both ways in most cases.

Not Sure if an Ohio Workers’ Compensation Attorney Can Help?

This is not an exhaustive list of injuries that are not covered by the workers’ compensation system, nor is it an exhaustive list of conditions and technicalities that workers’ compensation attorneys work with.

If you have suffered an injury at work and are not sure if you can seek compensation, do not hesitate to contact the expert Ohio workers’ compensation attorneys at the Bainbridge Firm for assistance. We want to do everything we can to help you obtain all the compensation and benefits you deserve.