Workers' compensation coverage is a no-fault system. In other words, even if the employee is partially at fault for the accident that caused his or her injuries, the employee is likely still eligible for workers compensation benefits. However, there are a few exceptions. In this blog post, we cover what injuries aren;t covered by workers comp.
What Is Workers' Compensation?
Workers compensation provides many types of benefits to injured workers. These benefits include medical benefits, which pay for hospital and healthcare bills as a result of the injury or illness, as well as a portion of lost income for the period in which the employee cannot work. In many states, there is a maximum amount of compensation that can be paid for lost income. For instance, in New Jersey, workers compensation benefits are 70% of the workers’ weekly pay, up to the state maximum.
Eligibility for Workers Compensation
States have different requirements for what types of businesses are required to carry workers compensation insurance. In New Jersey and New York, the vast majority of businesses must carry workers comp insurance. In order to qualify for benefits, employees must have suffered injuries from a work-related accident or illness. Common workplace accidents range from slip-and-fall accidents to chronic back injury to serious or fatal accidents.
Injuries Not Covered by 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.
If injuries are the result of one of the following, workers compensation benefits may not apply.
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 Injuries That Aren’t Covered
- Accidents deemed to be an act of nature
- Common one-time illnesses
- Pre-existing conditions
- On-the-job heart attacks
- Injuries suffered when not working
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.