Under New Jersey workers’ compensation law, a workers compensation claim is a no-fault claim, meaning that by virtue of the fact that you were injured on the job, compensation will be paid to you virtually automatic and there is no need for you to prove that your employer was at fault.
However, there are a handful of defenses that your employer can use to deny your claim and bar you from receiving workers’ compensation benefits. The purpose of this article is to familiarize you with these defenses and explain how they can be used to deny you workers compensation benefits that you would otherwise be entitled to receive.
If your employer can prove that you were intoxicated at the time you sustained the injury, either under the influence of alcohol or some other illegal substance, then you will be completely barred from receiving workers compensation benefits.
Willfully Injuring Yourself
If it is proven that you willfully injured yourself, your claim will be denied. The theory here is that some employees will deliberately injure themselves in order to receive compensation from their employer. When the employer can show that this is the case, it does not have to provide you with benefits and your claim will simply be denied.
Voluntary, Non-work Related Recreational Activities
Your employer can deny your workers’ compensation claim if it can show that you were injured while engaging in a voluntary, non-work related recreational activity. So for example, if you were at a company picnic and voluntarily decide to play softball with the other employees where you ended up getting injured, your claim can be denied.
An exception to this defense exist where participating in this kind of activity is normal and ordinary to the scope of your job function. So, if you are a baseball player, a sports coach, or working in some sort of recreational environment, the fact that you were injured while engaging in this activity would be inconsequential to your workers’ compensation claim because it is the nature of your job to participate in these types of activities.
An Act of God
An act of God is essentially anything that is beyond the control of human beings, such as a flood, tornado, or earthquake. Your employer would not be held liable for an injury caused by an act of God unless you were more exposed to this risk due to the nature of your job than the general public would be.
So, if an employee is working outdoors in a lumber yard and a flash flood occurs and he is drowned, there is really no way that his employer could have anticipated this or prevented it from happening. Therefore, the employer would ordinarily not be held liable.
On the other hand, if the employee is one who fights forest fires for a living, and is injured or killed while performing his duties, the employer would not be able to deny the claim because the very nature of the employee’s job put him at greater risk of being injured or killed by this particular act of God.
Injured While Engaging in Horseplay
If you are injured while deviating from your work functions for your own enjoyment and in a manner that is reckless, your employer would have ground to deny your workers’ compensation claim. In other words, if you are injured while playing or joking around with your fellow employees (or by yourself for that matter), your workers compensation claim for that injury is likely to be denied.
What This Means For Your Workers’ Compensation Claim
The main point to take away from all of this is not that there are several ways in which your workers’ compensation claim can be denied, but that a lot of these things are open to interpretation. Often, your employer or its workers’ compensation carrier will deny a valid claim if it simply resembles one of the above stated grounds for denying a claim.
For instance, let’s assume that you were injured at work while operating a piece of equipment and subsequently file a workers compensation claim. Let us also assume that when you were examined after the accident, traces of a drug that was prescribed to you by your doctor was found in your system and it happens to look very similar to those of an illegal drug.
In this case, your employer may try to use the situation to its advantage and deny your claim on the basis that you were intoxicated with an illegal drug at the time you were injured, when in fact you were not. Under these circumstances, you would have to appeal the denial of your claim to have your benefits reinstated and to obtain the compensation you are rightly entitled to receive.
Contact an Experienced New Jersey Workers Compensation Attorney
This is only a brief overview of the most common defenses that employers use to deny workers’ compensation claims. If you have been injured on the job in New Jersey and are having trouble receiving workers’ compensation benefits, you should seek the advice of an experienced New Jersey workers’ compensation attorney who can review your case and help you obtain the compensation you are rightly entitled to receive.