Does it matter who is at fault if a worker suffers an injury on the job? It can be very frustrating. You told the worker to follow a specific set of steps. They did not do so. It is their fault they have an injury. Do you have to pay for it? Generally speaking, workers’ compensation insurance covers worker injuries no matter who is at fault. There are limitations here, however. Business owners need to understand what they can expect in this situation. Here is a closer look.
Why Fault Does Not Matter
In most workers’ compensation insurance policies, the goal is to provide financial compensation to cover most or all of a worker’s injury costs if they happened during the normal course of business. That sounds pretty simple.
Yet, when you have a situation in which the employee’s actions or inactions cause the injury, it’s frustrating to know if your business has to pay for the losses. This is how workers’ compensation insurance generally works.
One big instance in which this does not apply is intention. If a worker specifically hurts himself or herself because they want to collect workers’ compensation coverage, they generally do not have protection. Coverage is not going to pay out if the worker specifically or maliciously tries to file a claim. This would be an instance of fraud. Be sure to report that to your insurance company.
Why Is This the Coverage Setup?
In most cases, workers’ compensation is a way for employers to avoid lawsuits. It’s true – a worker can sue you if he or she has a reason to do so.
However, by providing workers’ compensation insurance, there is less likely a chance of that occurring. In some systems, the worker accepting workers’ compensation surrendered the right to sue the employer, according to the Insurance Information Institute. This does not apply in all states, and some limitations apply across the board (such as in situations where claim limits are a concern).
What applies in your situation? If an employee suffers an injury, you have the legal right to question it, even if you provide the employee with your workers’ compensation. If you believe it was an intentional injury, tell your business insurance company about it. They will pursue this if it is worthwhile.
You cannot fire an employee for filing a claim either. You can work with your workers’ compensation insurance company to minimize the risk of having to pay out on claims that are fraudulent.
Also Read: Steps to File a Workers' Compensation Claim