Carrying workers’ compensation coverage is mandatory for most employers. The coverage available indemnifies the business if workers get hurt on the job. Coverage also protects employers from liability for medical conditions related to a worker’s employment. Cancer or carpal tunnel syndrome could be the result of an employee’s job functions.
Most businesses are simply grateful to have workers’ compensation coverage available when workers sustain injuries or get diagnosed with major medical conditions. The business avoids direct financial liability for medical costs and lost wages by providing workers’ compensation coverage. However, sizable claims can increase what the company pays for coverage. If employers believe that workers intend to manipulate the system, they may choose to respond assertively to a benefits claim.
Typically, workers’ compensation provides no-fault coverage regardless of what led to an injury or an illness. However, sometimes, fault can play a role in a company’s response to a claim. In the three scenarios below, a worker’s actions may affect their eligibility for workers’ compensation benefits.
1. Chemical intoxication at work
Employers typically require that workers submit to drug and alcohol testing after sustaining injuries on the job. If the worker fails the test, then the employer may be able to use that to defend against the claim. If an employer can show that impairment was the proximate cause of the worker’s injuries, then they may not be eligible for workers’ compensation.
2. Medical non-compliance
Employees generally have an obligation to follow the medical recommendations of the doctor overseeing their treatment. The failure to follow a treatment plan could lead to a delay in recovery.
Patients who refuse to undergo surgery, for example, might not make a full recovery. If the worker’s continued need for medical care or inability to work relates to their refusal to undergo treatment, then that could affect their eligibility for ongoing benefits.
3. Intentional injuries
Maybe a worker asked for vacation time that the employer didn’t approve. They might then stage an incident to justify taking a leave of absence because of their injuries.
There are many scenarios in which employers could potentially show that a worker hurt themselves on purpose to claim benefits. Fault does not matter if a worker hurts themselves through negligence or mistakes on the job, but it does matter if they hurt themselves intentionally.
Employers attempting to navigate a complex workers’ compensation claim may need assistance evaluating the situation and determining reasonable solutions. Seeking support when handling workers’ compensation claims and other employee-related matters can help businesses control their operating expenses.