Serious workers compensation injuries happen for many different reasons. Sometimes, no one could have prevented the injury. Other times, you might have avoided getting injured if you were being more careful.
When someone tells you that you were not being careful enough after an injury, you probably will wonder whether the workers compensation insurance company may fight or deny your case. In this article, I will discuss whether the insurance company can deny your workers compensation case if you were not being careful enough.
Yes. You can usually receive benefits when an injury is your fault.
A typical situation I encounter is someone who is driving a car for their job. Suppose this person crashes into the back of another vehicle. An accident like this would usually be their fault, but that person can still receive workers compensation benefits for the injuries from this accident.
Why should someone receive workers’ compensation benefits even if it is their fault they got hurt?
They get these benefits because workers’ compensation is supposed to be a no fault system. Under this system, it does not matter whose fault it is that you got hurt. You receive workers’ compensation benefits when you are injured doing your job.
The reason that you do not have to prove that someone else is at fault is that you can only recover limited damages in a workers’ compensation case. Workers compensation is about providing medical treatment and lost wage benefits when accidents occur so that someone can recover from their injuries and return to work.
Everyone makes mistakes. Sometimes those mistakes lead to injuries. Workers compensation is an insurance system that pays for those injuries when they occur on the job. It does not matter if the injury is your fault, you company’s fault, someone else’s fault, or nobody’s fault.
Personal injury is much different. In a personal injury case, you almost always have to prove that someone else was at fault in order to recover any damages.
Does it ever matter that I was at fault when I got hurt?
Sometimes, your fault can matter in a workers compensation case. But, it is not enough that you just made a mistake.
In order for your actions to prevent you from receiving workers compensation benefits, they have to rise to the level of willful misconduct. I have talked about willful misconduct in previous blog articles but wanted to discuss it again because the Georgia Court of Appeals and Georgia Supreme Court have recently decided cases on it.
In October 2015, the Georgia Court of Appeals decided the case of Burdette v. Chandler Telecom. Adrian Burdette was severely injured when he fell off a cell phone tower. His employer claimed that he disobeyed instructions from his supervisor about how to climb down the cell phone tower.
His employer denied his workers compensation claim by asserting that he was injured as a result of his willful misconduct. The State Board of Workers’ Compensation agreed with his employer and denied his claim.
Mr. Burdette appealed his case to the Georgia Court of Appeals. The Court of Appeals reversed the State Board of Workers’ Compensation’s decision and held that Mr. Burdette’s claim was not barred by willful misconduct. Jason Perkins filed an amicus curiae brief on behalf of the Georgia Legal Foundation with the Court of Appeals in this case.
The workers compensation insurance company then appealed the case to the Georgia Supreme Court. The Georgia Supreme Court said the Court of Appeals applied the wrong legal standard. They sent the case back to the Georgia State Board of Workers’ Compensation to reconsider the case under the correct legal standard. This decision could increase the chance that insurance companies deny more workers compensation cases based on willful misconduct.
Some might say that Mr. Burdette should not receive workers compensation benefits because he was not careful enough. But workers compensation is not about how careful someone was. It is about getting benefits to people who are injured doing their jobs.
Sometimes people make mistakes and get hurt doing their jobs. These mistakes should not prevent them from receiving the medical treatment and wage loss benefits they need while they recover from their injuries.
Willful misconduct covers situations where people intentionally do something stupid knowing that they are probably going to get hurt. Those type of actions prevent someone from receiving benefits, but true willful misconduct is rare.
Most of the time, someone is injured as a result of carelessness or a mistake. In those situations, I believe injured workers should receive benefits because workers compensation is intended to be a no fault system.