Certified Workers’ Compensation Specialist*

Certified Workers’ Compensation Specialist*

3 times fault can factor into workers’ compensation claims

Most Pennsylvania workers who get hurt on the job can file a claim for workers’ compensation benefits. The benefits can provide disability pay and payment for medical treatment. Coverage is available to workers in a broad assortment of different industries. Even part-time workers and those in industries that seem relatively safe, like retail, may qualify for benefits.

Typically, fault is not a factor that influences someone’s eligibility for benefits. If someone makes a mistake while operating heavy machinery or driving a vehicle for work, for example, they will typically still be eligible for coverage. Yet, occasionally, employers and insurance companies will push back against claims because they allege that the worker was at fault in a way that affects their eligibility.

What scenarios would make a worker’s fault relevant to a benefit claim?

When there are suspicions of fraud

Some workers would like to take a leave of absence from their jobs and may put themselves in a situation where they get hurt intentionally. If an employer can show based on conversations that a worker had or the circumstances leading to their injury that they hurt themselves on purpose to fraudulently claim benefits, that could impact their eligibility for coverage.

When workers violate company policy

It is generally necessary for employees to follow the law and any rules imposed by their employers to keep their jobs and be eligible for certain benefits, including workers’ compensation. If a worker’s injury is clearly the direct result of a violation of company rules, businesses can sometimes use a worker’s misconduct as a reason to deny their claim when they seek workers’ compensation coverage.

When intoxication causes an injury

Sometimes, the reason that a worker gets hurt on the job is because they are under the influence of drugs or alcohol. Employers often perform chemical testing after an incident in the workplace. If a worker fails a drug or alcohol test and the company can show that intoxication played a role in their injury, they may be ineligible for benefits.

In almost any other scenario, a worker’s contributions to the cause(s) of their injury will not affect their ability to obtain workers’ compensation coverage. With all of this said, every claim is unique. As a result, seeking legal guidance before filing a claim is generally wise.