Challenging any of these defenses by an employer will likely require expert legal help.
Employees often incur injuries in the workplace, with some of the most common on-the-job injuries being burns, cuts, sprains, bruises, and fractures. In 2021, 2.6 million nonfatal workplace injuries and illnesses were reported by employers in the private sector, according to figures from the Bureau of Labour Statistics (BLS).
The workers compensation scheme is designed to compensate employees who are injured or become ill as a result of their jobs. The scheme is intended to provide a safety net for both workers and employers in the event of workplace injuries or illnesses, as injured workers generally cannot sue their employers for workplace injuries, and employers are protected from costly lawsuits. This form of insurance provides a number of benefits which typically include wage replacement, medical coverage, disability, and death benefits.
If you have been injured as a result of your work and are pursuing a workers’ compensation claim, it is important to know that employers and their insurers often dispute valid claims or attempt to offer settlement amounts that do not accurately represent the extent of the injury or illness. A valid claim may be met with resistance and the onus may be on the employee to prove the extent of their injuries or illness and the fact that it is related to their work. In such cases, working with an experienced attorney can help you build a strong claim and ensure you are fairly compensated for your injuries.
To help you successfully overcome any challenges to your claim, this article has outlined some common defenses used by employers and insurers to avoid or limit liability, denying an employee the compensation they are entitled to.
Self-Inflicted Injuries
Only workers who are accidentally injured or are suffering from a work-related illness are entitled to compensation under the scheme. In some cases, an employer may assert that an employee intentionally injured themselves, for example, to fraudulently file a claim or was injured as a result of a fight that they started.
While this assertion denies the worker any benefits under the scheme, the onus will be on the employer to prove that the worker’s injuries were indeed self-inflicted and not accidental.
Negligence
A workers’ compensation claim can be denied if shown that the employee’s own negligence was the result of their injury or illness. An employer may contest a workers’ compensation claim on the grounds that the employee acted negligently when their injury or illness occurred.
For example, they may claim the employee failed to adhere to proper safety rules, violated their code of conduct, or was operating equipment carelessly or while intoxicated. The onus will be on the employee to prove that they did not act negligently and this may involve reviewing any surveillance footage and taking statements from eyewitnesses.
Horseplay
In general, an employee will not qualify for workers’ compensation if they were engaging in horseplay when the accident happened. ‘Horseplay’ or ‘fooling around’ refers to activities that are rough or boisterous, and can pose danger to the employee and their coworkers, for example, practical jokes.
Since they fall outside of the scope of employment duties, any related injuries will typically not be covered by workers’ compensation. However, an exception to this rule may be if the employer knew about and condoned horseplay as a commonly accepted part of the workplace.
Pre-Existing Conditions
One of the requirements of successfully claiming workers’ compensation is being able to prove causation. This means establishing a direct link between the employee’s injury or illness and their work-related duties.
An employer or their insurer may avoid paying compensation to a worker arguing that their injury was due to a pre-existing health condition and not work-related. They may also claim that the injury is related to an idiopathic medical condition, which means it can occur spontaneously and without any explainable cause.
The burden of proof will fall on the employee to provide evidence that directly links their injury or illness to their activities at work. If there is no clear link between the injury and work-related activities, it may be difficult for an employee to establish eligibility for workers’ compensation benefits.
Statute of Limitations
The statute of limitations is the legal time limit for filing a workers’ compensation claim. An employer may assert the worker failed to file their claim within the correct deadline of becoming aware of their injury or illness and has, therefore, forfeited their right to receive benefits.
Challenging any of these defenses by an employer will likely require expert legal help. By working together, an employee can gather the necessary evidence needed to successfully counter any defenses and ensure they receive the settlement they are entitled to.
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