Can employers deny workers’ comp benefits because of worker fault?

On Behalf of | Jun 10, 2024 | Workers' Compensation

Many people who get hurt at work rely on a special form of insurance coverage to pay their bills. The Pennsylvania workers’ compensation program can help pay for someone’s medical treatment when they have health challenges related to their work. They can also receive disability benefits that replace their wages.

Most workers expect a relatively simple and straightforward claims process after getting hurt on the job. However, some employees may face more conflict during a workers’ compensation claim than others. Sometimes, employers may try to avoid responsibility for workplace injuries by blaming the employee.

Particularly if there is surveillance footage or coworker testimony that can support the company’s claim that an employee was technically to blame for the incident in which they got hurt, can their employer use their mistake on the job to justify denying them benefits?

Fault usually does not affect eligibility

If employers could deny workers benefits for minor infractions, like running to care for a patient who needs immediate assistance in a hospital, then workers’ compensation coverage might leave thousands of people without the help they need to address their job-acquired medical conditions.

Even when there is clear evidence that an employee might technically be to blame for an injury, their employer usually cannot interfere with their benefits just because they made a mistake. No-fault benefits apply when the worker is to blame and when there is zero proof that the employer was at fault for the incident.

Does fault ever matter

The rules for workers’ compensation coverage in Pennsylvania require a case-by-case review. It is reasonable to say that overall workers don’t have to worry about fault limiting their eligibility for benefits.

However, there are exceptions to the no-fault coverage rules. Most notably, employers can sometimes deny a worker benefits if the company has proof that an employee’s chemical intoxication at work caused their injuries. A failed drug or alcohol test does not limit eligibility automatically, but proof that impairment caused an injury might. Occasionally, if employers have proof that a worker violated company rules or the law while on the job, that might also impact their eligibility for benefits.

Most of the time, fault does not influence whether someone can receive workers’ compensation benefits. Learning more about the details that determine the outcome of workers’ compensation claims can be beneficial for employees who are worried about paying their bills and affording medical care.