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There Are Some Injuries That Workers’ Comp Won’t Cover

The basic rules of workers’ compensation in Pennsylvania are as follows: All businesses with at least one employee must provide workers’ compensation coverage for employees. Usually, the company’s managers are required to buy an insurance policy that will pay out benefits to workers who are hurt on the job or who develop an occupational disease. Some of the largest companies have the option to “self-insure”—promising to set aside enough money to pay any claims—and are excused from buying insurance.

When an employee is injured at work in Pennsylvania, he is guaranteed that his medical expenses related to the work injury will be covered by the workers’ comp program. If his injury is so severe that he has to miss a lot of work, workers’ comp will also pay him income benefits—about two-thirds of his normal wages, but tax-free. In exchange for the guarantee that workers’ compensation benefits will always be available, the employee is forbidden to sue his employer or coworkers for any negligent actions that may have contributed to his injury.

That summary is clear and concise. It is also wrong.

Loopholes in the Pennsylvania’s Workers’ Comp Guarantee

Any program as large and complex as Pennsylvania’s workers’ compensation rules will have important exceptions. One of those is the guarantee of universal care. We have told you time and again that workers’ comp covers any on-the-job illness or injury, and that’s not quite true. In particular, there are three broad areas that define when a workplace injury will not be covered.

The Intoxication Exception

Were you drunk or stoned on the job, and did your inebriated condition contribute to your accident? Then forget about getting workers’ comp coverage.

The Horseplay Exception

Maybe you were taking the forklift for a joyride in the warehouse when you slammed into a wall and hurt you neck. Maybe you trying to play a prank on other employees in the break room, and that’s how you got burned by the pot of hot coffee. Incidents of horseplay at work can be harmless fun, but if someone is injured while engaging in behavior not related to work, the employer is not required to cover the accident.


If you knowingly make false statements about your injury claim, and those statements would have a meaningful effect on your benefits, then you will lose all your benefits when those lies are exposed. You may even be held responsible for paying back any benefits you have already received. In addition, fraud is a criminal offense, and you can be at risk for arrest and jail time. So, if you are ever tempted to exaggerate the extent of your back pain or lie about whether you sprained your ankle at home or at work—just don’t.

What Else Do You Lose When You Lose Your Workers’ Comp Case?

There’s another good reason to be mindful of the limits for Pennsylvania’s workers’ compensation guarantees: if your workplace injury was caused through your own negligence by intoxication or horseplay, the workers’ comp law does not shield you from being fired. Your misbehavior at work can mean you pay for your own medical care and you lose your job.

Sometimes, however, bosses happily lie to injured workers. They say that the company does not participate in workers’ comp, or that the employee does not qualify for benefits.

If you believe your boss is trying to avoid paying on a legitimate claim, call the workplace injury attorneys at Schmidt Kramer in Harrisburg. Call us at (717) 888-8888 toll-free to get answers to your questions, to schedule a FREE consultation with an attorney, or to request a copy of our essential report, Who Pays the Bills When You Are Injured at Work?