Although employees who suffer work-related injuries are entitled to benefits under most circumstances, there are still some defenses available to employers that may relieve them of their obligation to pay workers compensation benefits to their employees. The no-fault system does not require employers to pay benefits in every single situation. There are a few defenses that are available to employers that our Workers Comp attorney wants to make you aware of.
Understanding the no-fault system
As with most state’s workers comp systems, Missouri is considered a “no-fault” system which means that workers injured on the job are not required to prove that their employers were negligent or at fault when they file a workers comp claim. Specifically, employees only need to prove that they sustained work-related injuries and that the medical treatment they need is related to those work-related injuries. That beats having to meet the high burden of proving that their employers were somehow negligent in causing their injuries.
The benefits of a no-fault system
With all of the benefits of a no-fault workers compensation system, employees are still giving up something in return. Basically, in exchange for the workers compensation benefits employees waive their right to sue their employer for their work-related injuries. This is a benefit for businesses because workers compensation claims are typically much less than the amount recovered in a personal injury lawsuit.
Injuries resulting from willful misconduct
One thing that some employees don’t consider is the effect of their conduct relating to the injury and whether or not they may have been somehow responsible for the injury they sustained. For example, if there is evidence that you were injured at work but were knowingly violating company policies, you may not be entitled to workers compensation benefits. This can also include roughhousing, misbehaving or other purposeful or willful misconduct. In proving this type of defense, employers can use security videos or other surveillance, as well as testimony from co-workers or other witnesses.
Injuries that occur while under the influence of drugs or alcohol
As you might guess, employees who sustain injuries while they are at work and under the influence of illegal drugs or alcohol are not eligible for workers compensation benefits. Of course, in order for an employer to be successful in raising this defense, they must be able to establish that an employee was under the influence at the time the work-related injury was sustained, which can be difficult. Typically, this requires evidence such as blood or urine tests for drugs or alcohol. Testimony from co-workers can also be used, but alone may not be conclusive.
Injuries that are not work-related
The assumption cannot be made that claimed injuries are work-related. That means an employer can always argue that the employee’s claimed injury either occurred outside of the workplace or was not related to the employee’s job duties. If an employer can provide sufficient evidence to show either is the case, then the employee may not be entitled to workers compensation benefits. This can also include injuries that occur while the employee is not actually performing job-related duties. If you have questions about whether or not your injuries are job-related, discuss your situation with our Workers Comp attorney.
Understanding the workers’ compensation appeals process
The Worker’s Compensation insurance system is based on administrative law, which means an administrative agency, as opposed to a court of law, will oversee the entire system, including any claim contest or appeal. Administrative law judges are responsible for conducting hearings which are very similar to civil trials. If your claim is contested by the Worker’s Comp carrier, then your next step is to seek an appeal. You should get a Joplin workers compensation attorney to assist you.
Asking for reconsideration of the decision
The stages in the Worker’s Compensation Appeals process may vary depending on the state where you are employed, but here are the basic steps that everyone must take in order to appeal a decision denying Worker’s Comp benefits. The first step is to determine why your claim was contested or denied. If you are lucky, the matter may be resolved quickly. If you failed to submit a required document or some necessary evidence, you may be able to remedy the problem by simply supplying the required information. Once you do that, the Worker’s Comp carrier can reconsider your claim.
If you have questions regarding denied workers compensation claims or any other workers comp matters in Arkansas or Missouri, please contact the Cottrell Law Office for a free consultation. You can contact us either online or by calling us toll-free at (888) 616-6356.
He is licensed to practice law in the United States District Court for the District of Kansas, eastern Arkansas, western Arkansas, and western Missouri. He was Deputy Prosecuting Attorney in Crawford County, Kansas from 1987-1989.
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