When is employee fault grounds for denying a workers’ comp claim?

Employers generally have responsibilities when a worker gets hurt on the job in California. Whether you self-insure or pay for an outside policy, workers’ compensation in California is a no-fault program.

It doesn’t matter who is to blame for the incident that causes a work injury. The workers typically get benefits regardless of fault. They don’t have to prove that their employer did anything wrong or was negligent to get benefits. If you believe a worker contributed to their own injury, will their fault give you grounds to defend against their claim?

Worker fault could affect a claim in two situations

The no-fault structure of workers’ compensation coverage means that you can’t deny a worker coverage just because they make a mistake on the job. If they drop a box on their foot and break a bone or if they make a timing error while handling machinery and suffer a severe traumatic injury, they can seek benefits despite being the cause of the incident.

However, there are two circumstances in which a worker’s contribution to a work accident might affect their right to workers’ compensation benefits. The first is when someone causes the injury on purpose. If someone hurts themselves because they want benefits or time off, a company that can prove that intention could dispute their claim.

The second situation is when a worker causes their injury because they are under the influence of drugs or alcohol on the job. Intoxicated workers may not qualify for the benefits that they claim.

Understanding when you can push back against questionable workers’ compensation insurance claims can help your company minimize its costs and deter worker misconduct.