Workers compensation is designed to provide benefits to workers in the event of a workplace injury or illness. The system was originally designed as a way to shield employers from lawsuits, since employees generally cannot sue their employer for job-related injury. In turn, workers comp benefits are available to workers, regardless of fault. In other words, yes, you get workers comp even if it's your fault.
In some cases, however, an employer and their workers compensation insurance company may seek to deny benefits. Typically, they do this by claiming the injury did not happen at work and/or while you were working. But there are also some exceptions from the no-fault benefits.
Exceptions from Workers Comp
While workers comp is a no-fault system, there are exclusions from the benefits if the injury is considered to be the ‘fault’ of the employee in certain situations. It’s possible for your employer or their insurance company to deny workers comp benefits for one of these reasons. If your workers compensation claim is denied, you should speak with an experienced workers comp attorney about your case.
Horseplay & Fighting
Whether it’s a practical joke, tussle or more serious physical altercation, injuries that occur for these reasons may be excluded from workers comp benefits. Of course, that does not mean if you were the victim or non-aggressor in a situation that you are not entitled to benefits. Similarly, if your workers comp claim can show that certain behaviors were continually tolerated at your employer, you may also be able to still receive benefits. An experienced workers comp lawyer can advise you on options for your case and file an appeal if your claim is denied.
If your injuries occured while you were intoxicated, they may not be covered by workers comp. This would include a scenario in which an employee was drinking on the job as well as one in which alcohol or drugs were found through testing while receiving medical care.
Substance Abuse & Illegal Activity
Any injury that occurs because of a violation of the law may be denied. Like alcohol, if illegal drugs were found in your system after an injury, your employer could deny your claim for this reason.
Your employer could claim that you intentionally inflicted injury upon yourself. Keep in mind that the burden of proof is on the employer to prove this claim.
You have the right to file a claim for benefits after suffering a work-related injury; however, the process of actually going through the requirements for a workers comp claim can be challenging. If your claim is denied, you should know that you may still have options. An experienced workers comp attorney can handle your case and make sure you get the benefits you need.
Other Reasons a Workers Comp Claim Could Be Denied
Workers compensation claims may be denied for other reasons besides the exceptions to the no-fault rule. Typically, the question at hand is whether the injury occured at work or an illness/chronic condition happened in the course of employment. Other reasons a workers compensation claim could be denied include:
Injury Didn’t Happen at Work. New Jersey’s coming and going rule states that workers compensation benefits would not apply if your injuries happen while traveling to or from work. If you are injured in a workplace parking lot, for instance, you may be eligible for benefits.
You Weren’t Working When the Injury Happened. It’s possible that an employer could deny your claim by saying that you weren’t working when the injury occurred. However, even occasions like work social functions, travel, errand-running and other off-premises activities could be considered ‘working’ and employees can argue that the injuries should be covered.
Pre-Existing Condition or Injury. It’s not uncommon for an insurance company to claim that a pre-existing condition or injury caused or partially caused your current condition. An experienced workers compensation lawyer may be able to present evidence that shows this is not the case, negotiate with the insurance company and seek fair compensation.
Get Help with Your Workers Comp Claim
If you’ve been injured at work or if your claim has been denied, it's in your best interest to discuss your case with an experienced workers comp lawyer. At Brandon J. Broderick, Attorney at Law, our team offers expertise in workers compensation and employment law. Our compassionate client care and tenacious negotiation can get you the compensation you are entitled to and get your life back on track.
Contact us immediately for a free consultation to understand your options.