When it comes to workers’ compensation claims, many individuals are under the impression that if they caused the accident that led to the injury, they are not eligible for any benefits.
However, that believe is actually incorrect, and workers in most situations are entitled to benefits for an injury so long as it is sustained on the job. Does it matter who caused the accident when it comes to eligibility?
We have asked attorney, Alaina Sullivan and here is what she had to say:
What Is Workers’ Compensation?
Workers’ compensation is a type of insurance provided through an employer which allows employees who are injured on duty or on-the-job to claim benefits due to medical expenses and lost wages.
The policies can be through a private insurance policy or through the state’s workers’ compensation program. If an employee is injured while working and files a claim for workers’ compensation, he or she waives the right to pursue a third-party legal matter against the employer in a personal injury law suit for injuries sustained.
Each state has its own set of rules when it comes to workers’ compensation matters, and the governing law will be dependent on that state, unless the employee is a federal employee where federal workers’ compensation laws will govern.
For the most part, all jurisdictions view workers’ compensation as a no-fault legal issue. An employee is entitled to receive workers’ compensation benefits if the injury was the fault of the employee, the fault of the employer or even just the result of a freak accident where no one is to blame.
The main qualification lies on whether the injury is related to the employee’s job duties. For the most part, accidents that occur on the job are a combination of fault, and the employee will almost always play some part in why the accident happened, even if just a small percentage.
That small percentage, however, should not be enough to completely bar the employee from receiving benefits. A few exceptions do exist, though, that could prevent recovery of benefits.
Just because workers’ compensation is a no-fault system does not mean that the employee has free reign to act in whatever manner he or she wishes with no consequences. Certain situations do exist where the employee will be held responsible.
If the employee comes to work high or drunk, and his or her altered state leads to an accident, this behavior could disqualify him or her from benefits. Additionally, if the employee begins a fight or is injured as a result of horseplay, the employer may have reasons to dispute a workers’ compensation claim if one is later made.
If the employee’s misconduct falls outside of the scope of his or her work, injuries that have been sustained as a result of this misconduct will likely not be covered.
Another area where the employee would be liable for injuries is if he or she intentionally hurt himself or herself so that workers’ compensation could be received. If an investigation later discovers that this type of behavior has happened, the employer would have valid reason to dispute the claim.
The Gray Area
Like so many legal issues, workers’ compensation also comes with a gray area where there can be arguments made on both sides when an employee’s misconduct leads to an injury, whether the employer or employee should be responsible.
If the employee is goofing off at work and is injured because of his or her carelessness, unless the employer has made it clear that kind of behavior is not allowed at work, the employee may still be able to claim workers’ compensation.
In addition, if the employee is injured in a fight with another employee, and that type of behavior is expressly prohibited by the employer, the employee may still be able to file a claim if he or she was not the main instigator of the fight.
Many of these areas that are unclear are fact specific and will likely require some type of argument on the employee’s part as to why they should be allowed. They may also require further appeals in the event the employer denies the initial claim.
It is recommended in these situations that an attorney be consulted if the employee anticipates a fight in trying to get benefits.
Contact an Attorney Today
If you are in the process of pursuing workers’ compensation and have questions about how to proceed and whether your actions will keep you from receiving benefits, a workers’ compensation attorney can help review your case and discuss your options.
An attorney can listen to the facts of the case and can best advise you on how to proceed. Contact an attorney experienced in workers’ compensation law to schedule a consultation today.