Can I Receive Workers’ Comp Benefits If I’m at Fault?
Uh-oh. You weren’t paying attention and got hurt at work. Now you’re wondering, “Can I receive workers’ comp benefits if I’m at fault?”
Stop beating yourself up. These things happen!
Maybe you thought you were strong enough to pick up a box marked as a “2-person lift.” Or you missed a step in the procedures. Perhaps you spilled a chemical.
You may worry that your employer captured your injury on the security camera, proving it was your fault.
If you are at fault, unless you purposefully disobeyed a safety warning, you should still receive workers’ comp benefits.
Eastern Kentucky University reported the following top causes of workplace injuries in 2019:
- A bodily reaction to overexertion (such as when lifting objects or performing repetitive motions), which caused 31.0% of workplace injuries.
- Falls, slips, and trips, which caused 27.5% of workplace injuries.
- Contact with objects or equipment, which caused 25.8% of workplace injuries.
Given the types of injuries, it is safe to bet many of these occurred due to the fault of the employee. So, again, stop beating yourself up.
You’ve already got plenty of other things to worry about, such as medical care and compensation for your unexpected time off work.
So you’re wondering, “Can I Receive Workers’ Comp Benefits If I’m at Fault?” Put your mind at rest. Read on to see why you are more likely than not to receive workers’ comp benefits if you are at fault.
Georgia Is a No-Fault Liability State
The first thing you need to know is that Georgia’s workers’ compensation operates on a no-fault liability system.
According to the Georgia State Board of Workers’ Compensation, “Today, the workers’ compensation law provides for specific benefits to be paid to employees for injuries arising out of and in the course of employment, without regard to negligence or fault, and at the same time, provides the employer with limited liability.”
The key phrase here is “without regard to negligence or fault.” This means that you may still receive workers’ comp benefits if you are at fault.
The state board has a good reason for using a no-fault liability system.
The SBWC explains, “Prior to the passage of the Workers’ Compensation Act, an employee who was injured on the job could not expect benefits from the employer. […] Courts often denied recovery to employees by holding that employees assumed risks in taking the job, were negligent, or were barred from recovery by the negligence of a fellow employee.”
In other words, it was very easy for courts to deem employees at fault and refuse to make employers help these injured employees get medical care. Then, employees could turn around and sue employers, which often shut down small businesses.
Today’s system works to protect both the employee and the employer.
However, it is important to note that insurance companies are starting to deny more cases based on the “willful misconduct” defense due to the Chandler Telecom, LLC v. Burdette case.
This is even more reason to hire an experienced workers’ compensation lawyer who knows about that case and about the more recent case law further refining the “willful misconduct” defense.
What Georgia’s Workers’ Compensation Covers
According to the Georgia State Board of Workers’ Compensation Employee Handbook, “Any injury, illness or death arising out of and in the course of employment is by definition a compensable work-related claim. This means if employees are injured while performing assigned job duties during assigned work hours, they are covered under the workers’ compensation program.”
This type of coverage begins on your first day of work.
This means that if you sustain an injury while you are on the clock, you are entitled to still receive workers’ comp benefits if you are at fault.
For example, the employee handbook even clarifies that you may still receive workers’ compensation in Georgia if your injury resulted from haste or inattentiveness.
The Employee Handbook further states, “These types of injuries would be covered under the workers’ compensation program. However, employees are encouraged to follow company policies and safety rules and may subject themselves to company discipline if these rules are not adhered to.”
What Georgia’s Workers’ Compensation Does NOT Cover
While you typically may still receive workers’ comp benefits if you are at fault, there are a few instances where you are not covered.
For instance, the Georgia State Board of Workers’ Compensation Employee Handbook explains, “Injuries sustained while engaging in unassigned duties, during lunch and breaks, are not covered. In addition, injuries that occur during an employee’s normal commute to and from work are not covered.”
The key here is that workers’ compensation benefits will only be given if the injury is sustained while you are on the clock.
That’s not the only potential reason why workers’ comp benefits may be denied.
The Employee Handbook adds, “Workers’ compensation does not provide benefits for an injury or accident resulting from an employee’s willful misconduct (i.e., fighting, horseplay, willful act of third party for personal reasons, injuries related to alcohol or drug abuse).”
The key here is willful misconduct.
Suppose your work injury occurred because you have blatantly acted in a way that is inappropriate for the workplace, such as driving a forklift while intoxicated. In that case, you may not receive workers’ compensation benefits.
Why Work-Related Injury Claims Are Investigated
Some of the questions regarding whether you still receive workers’ comp benefits if you are at fault come from knowing there may be an investigation into your work-related claim.
This would make anyone nervous.
For the most part, this is standard procedure.
The Georgia State Board of Workers’ Compensation Employee Handbook explains, “Your employer and/or the company responsible for handling workers’ compensation claims generally investigate on-the-job accidents and injuries. Investigations are necessary to determine why and how the injury occurred, and to implement policies and procedures to make the workplace safer.”
With that being said, it is important to understand that insurance companies do not want to pay for work-related claims.
They want to make money – not give it away.
So, they will be investigating your claim to make sure it isn’t fraudulent.
As long as your injury occurred during work hours and wasn’t the result of willful misconduct, you should still receive workers’ comp benefits if you are at fault.
[Related Read: Is My Workers’ Comp Insurance Company Spying on Me?]
Don’t Confuse Workers’ Compensation with Personal Injury
Another reason people are unsure whether they will receive workers’ comp benefits if they are at fault is that they have confused these benefits with personal injury claims.
A personal injury claim requires fault. If you cannot prove someone else is at fault for your personal injury, you don’t have a claim.
Personal injury tends to be associated with “pain and suffering.” So when people talk about suing for pain and suffering, they tend to be discussing personal injury claims, such as car accidents.
In contrast, workers’ compensation is not a lawsuit.
Since it is a request for benefits, it does not require you to prove someone else is at fault for your injury.
Why Hiring an Experienced Georgia Workers’ Comp Attorney Is Critical
While we’ve explained that you should still receive workers’ comp benefits if you are at fault, it doesn’t mean it will be a walk in the park.
Workers’ compensation benefits do get denied.
[Related Read: 7 Steps to Take If Your Workers’ Comp Claim Is Denied in Georgia]
In addition to needing to prove the work injury occurred on the clock, you also need to make sure your employer can’t argue it was due to willful misconduct. Insurance companies may also raise concerns about pre-existing conditions.
Plus, even after you have started receiving workers’ compensation benefits, you have to deal with doctors pushing you to go back to work before you are healed and ready to return.
This is why it is wise to hire an experienced workers’ compensation attorney to help you navigate these challenges.
An attorney who has experience working with the Georgia State Board of Workers’ Compensation will know what needs to be done to get the benefits you rightly deserve.
It’s been proven that injured workers represented by experienced workers’ compensation lawyers get more benefits, better benefits, and higher settlements than people who don’t hire someone to fight insurance companies on their behalf.
If you’ve been injured on the job, contact us today for a free, no-strings-attached consultation.
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