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Does Fault Matter For Workers’ Comp?

Workers’ Compensation Lawyers

In general, workers’ compensation is a “no-fault” system, meaning that it provides benefits to employees regardless of who was at fault for the injury. As long as the injury or illness is work-related, the injured worker is typically eligible for workers’ compensation benefits, even if they caused their own injury. As experienced workers’ compensation lawyers – including those who practice at Polsky, Shouldice & Rosen, P.C. – can confirm however, there are certain situations where an employee’s actions or misconduct may limit or deny their ability to receive workers’ compensation benefits.

Standard “No-Fault” Workers’ Compensation:

In most cases, workers’ compensation is designed to cover injuries and illnesses that occur in the course of employment, regardless of fault. The following scenarios are generally eligible for workers’ compensation benefits:

  1. Accidental Injuries: If an employee sustains an injury due to an accident that occurred during the course of their work, they are typically eligible for workers’ compensation benefits. For example, if a construction worker falls from scaffolding while following safety guidelines, they would likely be eligible for benefits.
  2. Occupational Illnesses: Workers’ compensation also covers occupational illnesses or diseases that are a direct result of exposure to hazards in the workplace. For instance, employees who develop respiratory conditions due to prolonged exposure to harmful substances would likely qualify for benefits.
  3. Repetitive Stress Injuries: As discussed in a previous response, repetitive stress injuries (RSIs) can also be eligible for workers’ compensation, even if the employee’s work activities contributed to the injury.
  4. Preexisting Conditions Exacerbated by Work: If an employee has a preexisting condition, and their work activities worsen or aggravate the condition, they may still be eligible for workers’ compensation benefits.

Exceptions and Limitations

While the workers’ compensation system is generally no-fault, there are instances where an employee’s actions or misconduct could affect their eligibility for benefits. Some of the common exceptions and limitations include:

  1. Intentional Self-Injury: If an employee intentionally causes harm to themselves, such as attempting to commit suicide or self-harm, they are generally not eligible for workers’ compensation benefits.
  2. Intoxication or Substance Abuse: If an employee’s injury or illness is a result of being intoxicated or under the influence of illegal drugs while at work, they may not be eligible for workers’ compensation benefits. Some states have specific laws that allow employers to deny benefits in cases of intoxication or substance abuse.
  3. Willful Misconduct or Violation of Safety Rules: If an employee’s injury was caused by willful misconduct or a deliberate violation of workplace safety rules, they might be ineligible for workers’ compensation benefits. This varies by jurisdiction, and the burden of proof is often on the employer to demonstrate the employee’s misconduct.
  4. Horseplay or Personal Activities: If an injury occurs while an employee is engaging in horseplay or performing personal activities during work hours, their eligibility for workers’ compensation benefits may be questioned.

It’s important to note that the determination of whether an employee caused their own injury and whether it affects their eligibility for workers’ compensation benefits can be complex and may vary depending on the specific laws and regulations of the state or country where the injury occurred. In cases where there is a dispute over the eligibility for benefits, it is advisable for the injured worker to seek legal counsel to navigate the workers’ compensation claims process and protect their rights.