Workplace Injury My Fault: Can I Still Get Workers’ Comp?

Many people who are hurt on the job are afraid to report the accident because they think they are at fault. They worry that their job may be at risk if they admit to a mistake and that they would be denied workers’ compensation anyway because they did something wrong which led to the accident. In California, however, workers’ compensation coverage is generally not restricted based on who caused the injury. Below, our seasoned California workers’ compensation attorneys explain how fault plays into a workers’ comp case.

California Workers’ Comp Covers You Regardless of Who Caused the Accident

California’s workers’ comp system is considered “no-fault.” With very limited exceptions, which we discuss below, if you are hurt while on the job, then you are entitled to workers’ compensation coverage.

The minimum requirement for obtaining workers’ compensation benefits is that the injury was work-related. If you sustain an injury while at your workplace, you are entitled to coverage. If you are injured off-site while performing work-related tasks (such as a work-related delivery), you are likely entitled to coverage.

Whether your accident is caused by someone else or caused by your own mistake, forgetfulness, or general negligence, you are entitled to coverage. California workers’ compensation law is meant to protect workers who are injured on the job without wading into how and why the accident occurred.

Your employer or workers’ comp insurance provider may try to use your own “fault” as a reason to deny coverage but, in most cases, they cannot legally deny you coverage for that reason. There are, however, a few exceptions to the general rule.

Exceptions to Coverage

There are a few limited exceptions to the general rule. In certain situations, the specific circumstances leading to a workplace accident can prevent you from recovering workers’ compensation, even if your accident happened at work or otherwise while on the job. Workers who are injured as a result of their own gross negligence or deliberate misconduct may be denied benefits.

Denial based on gross negligence or misconduct most commonly occurs in the following situations:

Intoxication. If you were intoxicated due to consumption of alcohol or drugs while on the job, you may not be entitled to workers’ comp. Your employer or workers’ compensation insurance provider will need to demonstrate not only that you were intoxicated, but also that your intoxication directly led to the injury.

Fighting. If you start a physical fight with someone else, be it a co-worker or customer, you may not be eligible for workers’ compensation benefits for any injuries you incur. If you are defending yourself against an attack perpetrated by someone else, however, you may be able to recover benefits.

Horseplay. Workers who deliberately misuse dangerous equipment, such as by playing around while on the job, can lose out on workers’ comp coverage if their horseplay leads to a workplace accident. Benefits may be denied because horseplay is not considered an “on the job” activity, or because the worker is deliberately participating in an activity known to be hazardous, leading to their own injury.

Intentional Injury. Workers’ comp will not cover workers who injure themselves on purpose. Purposefully harming oneself in order to collect insurance benefits is not only grounds for denial of a claim, but may in fact constitute insurance fraud. It is illegal to stage accidents or otherwise harm yourself for the purposes of collecting insurance benefits.

Invictus Law, P.C. is a workers’ compensation law firm specializing in representing California’s injured workers. We strive to help clients get the care they need to obtain the best recovery possible and get on with their lives.

If your workers’ comp claim has been denied because they claim you were at fault, or if you have any other questions about your workers’ compensation claim, you need experienced legal representation on your side. We’re board-certified specialists in workers’ compensation. You don’t have to pay unless we recover on your behalf. Contact Invictus Law today for help.