Most people believe that if you are injured in a workplace accident or disabled by a workplace injury, you will automatically be entitled to have your medical care covered by workers' compensation insurance. Unfortunately, this may not be the case. If your injury occurred under particular circumstances, you may find that the workers' compensation insurer may deny your claim. What are these circumstances and are there exceptions to the rules? Here are a few points for you to ponder.
Were you injured while you were performing as the star pitcher in your company's softball league? Were you injured while you were participating in the sack race or while rock climbing at the company picnic? If so, you may have a hard time getting workers' compensation to cover your injuries. But there are exceptions to these rules.
If you are able to show that you were ordered to participate in these activities, in the name of team building, or as a part of your "reassigned" job duties, you may be able to argue that you were on the clock and therefore should be covered. You may also be covered if you were ordered to attend or your participation was mandatory.
Typically to decide whether or not it is covered, four basic questions are considered.
- Did the accident occur on property owned by your employer?
- Did your employer organize the event?
- Did your employer pay for the event?
- Did your employer benefit from your participation?
Whether or not you will be able to prevail will vary from state to state. Some states are much more lenient on approving this for coverage then others.
Under The Influence
One of the first things your employer may do following a workplace accident or injury is to require you to participate in drug testing. Although this has recently been under fire by U.S. Occupational Safety and Healthy Administration (OSHA), as many as 56 percent of manufacturers, as well as numerous other employers, still have the requirements built into their company's policies and procedures.
If they are able to show that you have been drinking on the job and were negligent in your job duties and this contributed to your injury, there is a high likelihood your claim will be denied. But if you are able to show that your "positive" drug screen came from a "controlled substance" or prescription medications, that you may or may not have reported to your employer that you were on, you may be covered under this exception.
This varies by your state and is often spelled out in their workers' compensation laws. Your workers comp attorney will be able to give you more information pertaining to your specific state.
There are safety rules, policies, and procedures, and other rules of conduct that your employer has put into place, to ensure safety in the workplace. If you are injured because you chose to break these rules or not abide by the policies and procedures that are in place, you run the risk of your claim being denied.
The exceptions include if you are able to show that the rule broken was not known, unreasonable, or not beneficial to you or the company. In some cases the burden of proof to show this will fall on your employer and not on you.
Even if you are injured due to one of these three reasons, you may still be eligible to be covered under workers' compensation insurance. Because your insurer may have grounds to deny your case, it is very important that you engage a workers' comp lawyer that provides a full array of workers comp services. They will be able to work with you on your case on an individual basis.
Contact an attorney from a firm like Walz Law Office for help.