One of the main tenets of the workers’ compensation system is the payment of benefits regardless of fault. Even if an employee caused his own injury, he is typically still able to obtain benefits. The system specifically addresses this issue to help protect both employees and employers. Employees are able to obtain medical care and wage replacement so they can get back to work, and employers are left facing only limited liability.
The general rule does have limits, however. There are a number of circumstances in which an employee’s actions may disqualify him from receiving worker’s compensation benefits. It is important to understand these situations and what your rights may be. Here, we examine some of the more common behavioral issues that can affect workers’ eligibility.
Certain Behaviors Can Disqualify an Employee From Workers’ Comp Benefits
The guidelines for workers’ compensation eligibility in Iowa generally specify that a company employee must suffer an injury in the course of work. There are some circumstances under which an employee can rightfully be denied compensation for an injury sustained at work, however. Most states have similar rules about these situations, and they include:
- Horseplay. When an employee engages in horseplay on the job and is injured as a result, he may not be eligible for compensation. Note, however, that there have been exceptions to this rule which we will discuss below.
- Drug or alcohol use. If an employee is injured while under the influence of alcohol or drugs, an employer is not responsible for providing payment for an injury sustained at work. In these cases, the intoxication must have been the main factor in the injury.
- Self-inflicted injury or fighting. The state of Iowa specifies that “willful intent to injure the employee’s self or to willfully injure another” can disqualify an employee from benefits. Employers do not have to pay benefits to employees whose injures are sustained in a fight, even if the fight happened at the place of business or even related to business disagreements.
- Acting in direct violation of stated company policy. Employers have the right to set guidelines and rules to help promote the safety of their employees. Workers who are aware of these policies but choose to act against them may not be eligible for benefits.
- Acts of a third party. If a third party causes injury to an employee—deliberately or through negligence—the employer is generally is not compelled to provide compensation.
Obtaining Benefits Despite These Behaviors
While it may be difficult to obtain workers’ compensation benefits if you are injured in one of these scenarios, it still can be possible. Every case is unique, and often employers bear the burden of proving that the workers’ behavior disqualifies them from eligibility. In many of these cases, the employer must be able to prove:
- The behavior was the main cause of the injury. If an employee is under the influence of alcohol or drugs and is injured, it still must be proven that intoxication was the primary cause of the injury. In 2011, a Montana park worker was mauled by grizzly bear on the job after using marijuana. The courts there, however, ruled that his drug use played no role in the attack and awarded him compensation.
- The behavior was outside the accepted norm at the workplace. The workplace culture can also play a role in determining compensation eligibility. If horseplay routinely occurs and is either encouraged or ignored by the management, the worker may still obtain benefits. Additionally, company policies that are routinely and widely violated with impunity may not bar an employee from receiving compensation. Finally, there are situations in which use of alcohol occurs as a normal part of employment, and those circumstances can be covered by workers’ compensation.
An Experienced Iowa Workers’ Compensation Attorney Can Help
If you or someone you love has suffered injuries at work in a situation related to any of these behaviors, it may be difficult to obtain workers’ compensation benefits. However, an experienced Iowa attorney can examine your unique situation and help you determine how best to move forward. The Iowa workers’ compensation system exists to protect employees and ensure their well-being. Even if you are worried your claim will be denied, an attorney may be able to help.
At Pothitakis Law Firm, our experienced legal team can investigate your claim, secure expert testimony, prepare paperwork, and frame your case to help you obtain the maximum compensation available. Take a moment to fill out the contact form on this page, and you’ll get a prompt response from a member of our team who can answer your questions and schedule a free, no-obligation consultation.