If you are employed in California, then there is a good chance that you are covered by workers’ compensation insurance that is purchased and maintained by your employer. But being covered by a workers’ comp policy doesn’t guarantee that you will receive benefits if you get hurt while working. As with any insurance policy, there are disqualifiers that can stop you from getting workers’ compensation benefits.
In California, a worker can be disqualified from receiving workers’ comp benefits in these situations:
- Intoxication: If the worker was intoxicated at the time of their injury, then they can and likely will be barred from making a recovery through workers’ compensation. At the time of the accident, it will be noted if the employee seemed drunk, which could spell trouble for that employee when filing a claim. Complications could arise if the employer instructed or encouraged the employee to drink, though. For example, if you were at a mandatory work holiday party that served alcohol and you tripped down the stairs after having a few drinks, then you might still be eligible to receive workers’ comp benefits. Getting an attorney involved can help clear things up.
- Intentional harm: Workers’ compensation only covers work-related accidents. If you intentionally harm yourself at work, then you will be disqualified from getting benefits. You can also be disqualified if you intentionally engage in an activity that you reasonably should have known could very likely result in your injury, e.g., “walking” a tall ladder while you are atop it. Insurers sometimes try to deny a claim by saying the employee was intentionally trying to get hurt, even if this is not apparent.
- Fistfight: Workers’ compensation will not cover any injuries you suffer while in a fistfight or similar violent altercation with another person if you were the instigator. If you pick a fight or provoke someone into fighting you at work, then you are risking your health, employment, and workers’ comp benefits all at once.
- Criminal activity: Similar to losing coverage if you start a physical altercation at work, you can also lose workers’ compensation coverage if you are knowingly breaking the law when you are injured. Specifically, you can be disqualified from receiving workers’ comp benefits if you are hurt while committing a felony or a violent crime. For example, a worker hurts their back while trying to steal heavy merchandise from their employer. No workers’ comp coverage will be provided to help treat that back injury.
- Recreation: Workers’ compensation typically does not cover any injuries that are suffered while a worker is engaging in voluntary recreation related to their employment or while they are off duty. Going back to the holiday party example, if attendance was completely optional and you weren’t clocked in during it, then you probably could not receive workers’ comp if you are injured while at the party. Unusual circumstances could exist to change the disqualification, though, so you should always talk to a workers’ comp attorney if you aren’t sure.
- Termination with no prior notice: You don’t lose your right to workers’ compensation benefits if you get fired after being injured on the job. However, your employer and their insurer can deny or challenge your claim if you file it after you are terminated, and you never notified your employer previously about your injury. They would probably be skeptical that your injury even existed. This underlines the importance of notifying your employer as soon as possible if you get hurt at work or if you notice a work-related injury developing, such as a repetitive strain injury (RSI).
For any questions about worker’s compensation disqualifiers in California, and how they can affect your claim, contact Alvandi Law Group, P.C. at any time.