Common Defenses to Workers’ Compensation Claims

The North Carolina Workers’ Compensation Act requires employers with at least three employees to purchase workers’ compensation coverage for their injured and sick workers. Coverage includes the payment of medical expenses, a portion of lost wages, and other benefits.

Employees suffering an on-the-job injury or illness can file a workers’ compensation claim for these benefits. However, you must review the application and supporting documents to determine whether your employee is entitled to benefits through your insurer.

Not all workplace injuries and diseases qualify for workers’ compensation coverage. If you believe the claim filed with your insurance company isn’t valid, you should hire an experienced workers’ compensation defense lawyer immediately.

The most common defenses you can use against a workers’ compensation claim are below.

Self-Inflicted Physical Injury

Accidents at work can happen, and employees can be injured. Workers’ compensation insurance provides benefits when injuries occur accidentally. However, the insurance company does not have to pay if the employee intentionally inflicted injuries upon themselves.

Sometimes, employees will hurt themselves on purpose to take time off from work and receive payments for their expenses. You must prove that the injured worker inflicted self-harm to defend against the workers’ compensation claim.

Alcohol or Drug Intoxication

A common defense against workers’ compensation claims is employee intoxication. You don’t have to provide benefits to workers injured in incidents when alcohol or drugs were a factor. If your employee were intoxicated at the time of the accident, their injuries wouldn’t qualify for coverage.

Proving intoxication can be a challenge. It’s crucial to get tests done immediately following the incident before the drugs or alcohol leave your employee’s system. If the results show they were impaired when they suffered an injury, you could avoid paying their claim.

Non-Work-Related Injury or Illness

The worker’s illness or injury must occur while they are performing their job-related duties to qualify for coverage. It can result from an accident at the office or another location. As long as they’re doing work as part of their employment, they qualify for workers’ compensation benefits.

If the injury occurred while the employee was off the clock, you usually don’t have to pay their claim. Proving the injury isn’t work-related could be as simple as providing their timecard as documentation. If their medical records reflect the injury happened outside of their normal working hours, you should be able to prove they weren’t doing their job at the time of the incident.

Reckless Behavior

Workers’ compensation insurance should not cover accidents resulting in injuries due to an employee’s reckless actions. Employees must display professionalism on the job and perform their tasks safely. If they engage in horseplay or otherwise behave recklessly, they’re likely not entitled to benefits.

You could deny their claim but must provide proof of their misconduct. You could locate witnesses who saw what happened or obtain security video footage of the employee prior to the incident. Either way, there must be evidence that the workplace injury happened because of the employee’s actions.

Speak to an Experienced Workers’ Compensation Defense Attorney Today

At Mullen Holland & Cooper P.A., we have represented employers against injured workers’ accident claims since 1950. We understand the challenges you face while fighting a claim your employee filed to receive benefits through your insurer. You should not be forced to provide benefits if the injured worker isn’t entitled to payments.

If your employee filed a workers’ compensation claim, you should contact Mullen Holland Cooper P.A. immediately. We can review the circumstances of the injury or illness to determine whether your employee qualifies for coverage. We will build a solid plan to defend you so you can close out the claim and move forward with normal business operations.

You can depend on our legal team to fight for you. Call us at 704-864-6751 today for your consultation with a knowledgeable North Carolina workers’ compensation defense lawyer.