For certain types of insurance claims, fault is a major consideration. After a car crash, for example, responsibility for the collision influences what coverage is available. For other types of insurance, fault has very little bearing on coverage and personal financial responsibility. People making use of their health insurance coverage, for example, typically have the same coinsurance and deductibles regardless of the underlying cause of their medical challenges.
Workers’ compensation benefits are a crucial workplace protection for Connecticut employees. Employers carry these policies to indemnify the company if workers get hurt. Unusual incidents can occur in any job environment, meaning even the safest profession can put a worker in the hospital. Work incidents can have a variety of different underlying causes.
Can the fault of the injured or sickened worker influence their right to pursue workers’ compensation benefits?
Fault usually doesn’t matter
Workers’ compensation provides no-fault coverage. Workers do not need any evidence that their employer was somehow to blame for an incident to be eligible for benefits. Additionally, they generally don’t have to worry about losing their eligibility for benefits just because an employer might have evidence supporting the claim that the worker is at fault for the incident.
For example, an employee talking over their shoulder to a coworker might not notice a spill on the floor. They could fall and break an arm. The company might have a degree of fault for failing to maintain clean premises, and the worker may also have a degree of fault because they failed to monitor their surroundings. That fault does not affect eligibility for benefits or how much support the employee receives.
There are times when fault matters
While workers’ compensation is typically available to those with medical issues caused by their careers regardless of fault, there are a few notable exceptions. If an employee fails a drug or alcohol test and the employer can show that intoxication caused the worker’s injury, the employee may not be eligible for workers’ compensation benefits.
Similarly, if the company has evidence showing that the worker hurt themselves on purpose, possibly in a bid to qualify for disability leave, that might also impact eligibility for workers’ compensation benefits. Occasionally, the refusal to comply with medical instructions during a claim could also raise questions about whether the employee is at fault for the continuation of their symptoms. Most of the time, however, personal fault has no bearing on workers’ compensation eligibility.
Professionals who need to file benefits claims may need help learning the rules and handling the complex paperwork required to request benefits. Reviewing the circumstances that led to a work injury with a skilled legal team can help employees determine if they are eligible for workers’ compensation benefits.
