One main reason for workers’ compensation is to provide the coverage for medical attention employees need regardless of who is liable for the circumstances that caused injury or illness. That being said, there are some occasions when insurers can deny a claim based on employee fault.
When you file a workers’ compensation claim, your employer and the insurance company typically conduct investigations into the cause of the injury or illness. This investigation helps employers correct dangerous work conditions, but it also helps identify claims not covered by New Jersey workers’ compensation law, such as the following:
Intentionally self-inflicted injuries
Employee intoxication or the unlawful use of controlled dangerous substances
Willful failure of a worker to use appropriate protective devices
Horseplay or skylarking
The bottom line is that any injury caused by negligent acts on the part of the employer, other workers or the injured employee are covered. However, injuries caused by the willful acts of the victim are most likely not covered.
Keep in mind, however, that employers want to keep their number of claims low, and insurance companies do not want to spend money unnecessarily. Their investigations can be unfairly skewed against accident victims just to avoid paying claims. If you know you did not intentionally act in any way that would cause your injuries, you need to defend your rights to compensation.