In every occupation and industry, people make mistakes. It is human to err. However, sometimes a mistake on-the-job can cause an accident and serious injuries that take the injured worker off their feet for a while to recuperate.
You might know that workers’ compensation helps provide financial coverage if you get hurt at work. But can you get workers’ compensation if your accident is your fault? Thankfully, since workers’ compensation is not a fault-based system, you should be able to get needed benefits for your own injuries caused by your own mistakes.
Trading No-Fault for No Lawsuits
It might seem suspicious that you can get workers’ compensation benefits for injuries that you caused. In a personal injury claim, you wouldn’t have that option. What is special about workers’ comp that lets you pursue benefits like medical treatment coverage and missing wages regardless of fault?
The truth is there is a bit of a caveat. When you are provided workers’ compensation benefits, you cannot also file an injury lawsuit against your employer for further damages, in most situations. Essentially, your employer guarantees that they – or their insurer – will provide necessary damages to you if it means they cannot get sued for potentially more. It is a trade-off that most employers and employees enjoy.
Exceptions to the No-Fault Rule
There are situations when your workers’ compensation claim can be denied due to a question of liability, though. If your employer or their insurance company has reason to suspect that you were acting egregiously negligent when you were injured, then they could have grounds to challenge your claim.
There are usually just two reasons why fault and liability are considered in a workers’ comp claim:
- Intoxication or impairment: Workers who hurt themselves while they are intoxicated by alcohol or impaired by a drug might not be able to receive workers’ compensation for their injuries. The idea is that the worker should have known that intoxication or impairment would significantly increase their chances of making a mistake and getting into an accident.
- Intentional negligence: Injured workers also cannot receive workers’ compensation for injuries that they intentionally caused. For example, if a worker fell off a ladder and got injured but security camera footage showed that worker intentionally shaking the ladder just before the fall, then it would be expected of the insurance company to deny the claim.
Can You Appeal a Denied Workers’ Comp Claim?
If you have been accused of intentionally causing your workplace accident or that you were intoxicated when it occurred, you do not have to sit down and accept that you cannot get workers’ compensation. No matter what state you call home, you can challenge a denial or file an appeal to have your case reviewed further.
In some states, like Florida, you can first file an internal appeal, which basically asks the original insurance adjuster to look at your workers’ compensation claim again. There are times when this process is enough to get a new, favorable decision. Although, you should not count on this solution working as well as you would like since insurance companies rarely like to backtrack on denials.
Instead, you might need to plan to officially file a formal appeal to your state’s workers’ compensation board or division. This type of appeal will allow the board to review the case from a neutral third-party perspective free from any insurance company bias or ulterior motive. Convincing the workers’ comp board or division to side with you will not be easy, though, especially considering that the defending insurance company can argue against you throughout your appeal.
It is highly advised that you only prepare an appeal, be it an internal or formal one, with the assistance of an experienced workers’ compensation attorney. They can help you form a stronger argument, meet legal deadlines, respond to insurance company inquiries, and more.
If you live in Daytona Beach and need a workers’ compensation lawyer to help with your claim, call (386) 333-6613. Politis & Matovina, P.A. provides legal counsel to people who have not yet filed their claim and representation to clients who did file but were denied. We are available 24/7 for your convenience.