New Jersey’s workers’ comp system is considered “no fault,” meaning that workers injured on the job do not need to prove that their employers were in any way negligent or at fault in order to bring workers’ comp claims. In other words, injured employees do not have to meet a high burden of proof in order to receive workers’ comp benefits – only that they sustained injuries while on the job and that any resulting medical treatment is related to those injuries.
This no-fault system is very beneficial for injured employees; but, it does not come without a tradeoff. Essentially, in exchange for receiving workers’ comp benefits, New Jersey law precludes injured employees from suing their employers on the basis of those injuries. Why does this matter since the injured worker gets workers’ comp benefits anyways? The short answer to this is that workers’ comp settlement amounts are generally much less than personal injury lawsuit settlements.
Even though injured workers generally are entitled to workers’ comp benefits in most situations, there are some defenses available to employers that may allow them to forego paying these benefits.
Despite the no-fault system as described above, employers are not required to pay out workers’ comp benefits in every situation where an employee is injured at work. There are a few defenses available to employers that may leave the injured employee out of luck. Here are some of the most common defenses available to employers in workers’ comp situations.
- An employee is injured at work while under the influence – As you might expect, if you are under the influence of alcohol or illegal drugs at the time you suffer an injury on the job, the employer may be relieved of its otherwise normal obligation to pay workers’ comp benefits. Generally, for an employer to claim this as a valid defense, there must be sufficient evidence to demonstrate that the employee was, in fact, under the influence at the time of the incident. This evidence may be found in medical records (e.g., blood and/or urine tests and the observations of the medical providers). The testimony of co-workers and other witnesses is also relevant evidence.
- Willful misconduct or fooling around – If there is sufficient evidence to demonstrate that an employee received an injury at work while willfully violating safety policies and/or purposefully misbehaving, roughhousing, etc., employers may have a legitimate basis for denying the employee’s workers’ comp claims. Evidence that may be relevant includes surveillance or security video footage and the testimony of the employee, co-workers, and other witnesses.
- Injuries caused outside of work – If the employer possesses sufficient evidence to demonstrate that the claimed work-related injury took place outside of the employee’s terms of employment, the employer may deny paying out workers’ comp benefits.
- Self-inflicted injuries – If sufficient evidence exists that the employee self-inflicted injuries upon him or herself, the employer’s obligation to pay workers’ comp benefits may be reduced significantly or even eliminated altogether.
Each New Jersey workers’ compensation claim is unique and the benefits are specific to the situation. If an employer and workers’ comp insurance companies denies you benefits due to an alleged defense, it is important to seek legal counsel right away in order to protect your rights. We may be able to help you overcome one of these defenses. Call Petro Cohen, P.C.at (888) 675-7607 or complete our online form as soon as possible to request your consultation. There is no cost to speak with us. We can provide you with a comprehensive review of your basic rights if an employer denies your claims.