You probably know that you might be able to obtain workers’ compensation benefits if you are injured on the job. For example, if you were stocking merchandise and a box fell on your foot, causing a fracture, you can expect that your medical expenses will be covered by their employer’s workers’ compensation insurance.
But what happens if your own negligence caused your work-related accident? Are you still covered by workers’ compensation? For the most part, you should be because workers’ compensation is a no-fault system.
What Does No-Fault Mean?
The purpose of workers’ compensation is to provide wages, medical treatments, and, if necessary, disability benefits to injured workers regardless of who was at fault for the accident. Under most circumstances, an injured worker can expect to be covered by the policy due to this no-fault basis.
You can even admit to causing your own injury due to a mistake and still be eligible for workers’ compensation benefits. For example, imagine that you cut your hand while using a box cutter because you were not paying attention to your hand placement. Although no one else was involved in this accident and it could have been prevented with more care, it does not disqualify you for receiving workers’ compensation insurance.
When Fault Matters in a Workers’ Comp Claim
However, workers’ compensation benefits are in no way guaranteed. Insurance companies always have the opportunity to investigate or deny a claim if they do not think the accident or injuries qualify for coverage. There are also some circumstances in which an injured worker may not be eligible to collect benefits because fault enters the equation. In other words, a worker who causes their own injury can be denied benefits for that reason alone.
An injured worker may be denied workers’ comp benefits if that worker:
- Violated an express company safety policy: In some workplaces, there are strict safety rules that must be followed, or else the employee can be terminated for endangering themselves and others. A worker who intentionally violates such an express safety policy could be denied workers’ compensation benefits for making that decision. For example, if a shop worker is required by their company to wear safety gloves to protect their hands, and the worker was injured because they neglected to wear their gloves, they may be denied benefits. However, employers will still have a difficult time denying a claim for this reason because the argument can be made that a supervisor should have noticed the employee was breaking a safety rule and intervened before the accident happened. It also still involves a legal gray area concerning the no-fault standard for workers’ comp claims.
- Engaged in horseplay at work: Roughhousing at work is usually strictly prohibited in employment contracts. If an employee is hurt while “goofing around” in a way that they reasonably should have known could have caused an accident, then they might not be eligible for benefits. For example, imagine if a worker was running around a retail store and playing catch with another employee, who was tossing staplers and hole punches at them. If one of those staplers hit them in the face and they get hurt, then they might not receive any benefits through a workers’ comp claim because the behavior was disallowed and obviously dangerous.
- Intentionally hurt themselves: An employee who purposefully harmed themselves is not considered to have been injured “in the course of their work duties.” To that end, workers’ compensation coverage would not apply to that situation. However, there may be exceptions if work-related stress over a long period of time is considered to have contributed to the incident. For example, an employee who causes self-injury due to a work-induced mental health difficulty could possibly be provided medical care costs.
- Suffered an injury while intoxicated or impaired: Since the vast majority of workplaces have strict workplace drug and alcohol policies, a violation of these policies would render the employee ineligible for benefits if he or she is injured. Such denials are further backed by the fact that workers’ compensation benefits can be denied if the injured employee was engaging in unlawful activities at the time of their accident. Public intoxication and the use of narcotics in public is strictly illegal essentially everywhere, so claims of this sort are often simple for an insurance company to deny.
Challenge Denials with an Attorney’s Help
Any of the above reasons can result in a complete loss of benefits or may cause a worker’s benefits to be drastically reduced. However, because each case is different, it is crucial for injured workers to consult with a workers’ compensation attorney to discuss their benefits eligibility. Many workers are surprised to find that even when an injury was partially or wholly their fault, they may still be eligible for at least some benefits. Workers’ compensation laws can be complex, so injured workers shouldn't attempt to handle their own cases.
A work-related injury can place significant financial stress on you. Don’t add more by managing your claim alone. If you’ve been hurt and need assistance, please contact The Law Offices of Nathaniel F. Hansford, LLC in Atlanta to schedule a meeting with our lawyers. Free case evaluations are available when you call (770) 629-9321.