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My Injury Was My Own Fault. Can I Be Denied Workers’ Comp?

The workers’ compensation system exists to offer economic relief after a workplace injury. Generally, workers’ compensation does not use any fault-based system for determining coverage, but some employee actions may disqualify an injured worker from workers’ compensation coverage. If you recently suffered an injury at work due to your own mistake or you otherwise caused your own injury, you may not qualify for workers’ compensation benefits.

Determining Your Eligibility

Most states approve workers’ compensation claims regardless of fault, including injuries workers cause themselves through honest mistakes or basic negligence. For example, a construction worker hammering a nail into a beam could accidentally miss and hit his own hand, suffering a serious injury that causes him to miss work. If the employee did not intentionally injure himself to fraudulently claim benefits, the employee’s injury would likely qualify for workers’ compensation.

When you report a workplace injury to your employer, the employer must provide the necessary materials for filing a workers’ compensation claim. The workers’ compensation insurance carrier will provide you with a list of approved physicians in your area who you can see for treatment. Although you can have any available doctor treat you in an emergency, you must return to an approved doctor’s care once the emergency stabilizes. The physician will examine your injuries and provide you with a disability rating that will influence your workers’ compensation benefits.

The workers’ compensation board in your state will review your claim and the physician’s report to determine your eligibility for benefits. Most workers’ compensation claims cover the injured employee’s initial medical expenses, but the benefits for lost income during recovery based on various factors.

What Disqualifies an Injured Employee From Receiving Workers’ Compensation Benefits?

Some actions will outright disqualify an employee from receiving workers’ compensation benefits. Generally, workers’ compensation applies to honest mistakes and unavoidable injuries from workplace hazards, but it does not apply to injuries sustained while acting outside the scope of the employee’s job duties.

  • If an employee suffers an injury due to substance abuse in the workplace, this would likely disqualify the employee from workers’ compensation benefits. For example, a forklift driver shows up to work drunk and crashes a forklift into a rack of merchandise, suffering severe injuries. The employee did not make an honest mistake; operating heavy equipment under the influence of drugs or alcohol is an extremely dangerous choice that would place liability on the employee.
  • Employees who suffer injuries from interpersonal violence in the workplace would not qualify for workers’ compensation benefits. For example, if a fight broke out between two employees and one employee suffered severe injuries, the employee would not qualify for workers’ compensation benefits if the employee willingly participated in the fight. If an employee assaults another employee, the victim has a right to self-defense and may qualify for some workers’ compensation benefits if the fight was not the victim’s fault and the victim did not encourage it.
  • Injuries from horseplay at work may not qualify for workers’ compensation benefits. Some jobs involve lots of time waiting for others to complete their tasks, waiting for deliveries, or other periods of downtime that can make employees restless. Most workers’ compensation insurance carriers will not cover injuries from horseplay.

If you sustained injuries at work and have concerns about your degree of fault for your damages, consulting with a workers’ compensation attorney is a wise decision. Your attorney can help you determine your eligibility for a workers’ compensation claim and help you complete your claim paperwork.

A Phoenix workers compensation attorney can also help you determine any available alternative routes to recovery if workers’ compensation is not available to you, such as a personal injury lawsuit against the party responsible for your injury. If you know you are at least partially at fault for your workplace injury, an attorney can potentially help you minimize your liability and help you qualify for workers’ compensation benefits.