Factors That May Determine Whether You Win A Disputed Workers Comp Claim

Your employer or the employer's insurance company is disputing your workers compensation claim, stating that your fall was not related to your job. You've missed work because of your injury, and now you're wondering whether you do actually have a case. You may want to contact a workers compensation lawyer for a free consultation. Certain circumstances can make the difference as to whether you're eligible for workers comp payments or not.

Specific Factors in Workers Comp Decisions

If an insurance carrier questions the validity of a workers comp claim, the underwriters may research whether similar claims have been held up by an arbitrator, the workers compensation commission or in court. Consider two possible examples and whether they are similar to your claim.

Falling on a Clean, Dry and Stable Stairway

If an employee is on a stairway because of a task required in the job and falls on the stairs, typically workers comp payments are provided. It doesn't matter whether the stairway was entirely safe and the employer or the underwriters believe the individual should not have fallen. The employee still was injured while on duty. 

The situation becomes murkier if the employee was on a stairway simply because the work space is on the second or third floor, or if it was break time and he or she wanted to go outside. Legal representation may be necessary to sort through the details.

If your case is similar to this latter example, you shouldn't simply give up. An arbitrator or a workers compensation commission may very well side with you. Having to climb stairs to reach the work site or to take a break still is intrinsic to the job.

Tripping on a Clear Floor

If the employee trips on a clean, dry and clear floor, the employer or the insurance carrier may dispute a workers comp claim. They may state that in general, the simple act of walking in a safe area is not a potential work hazard.

However, if the employee was carrying something related to the job and couldn't break his or her fall because of that, the situation is more complex. 

Comparative & Contributory Negligence

The concepts of comparative and contributory negligence are used in personal injury claims, either reducing or negating an injured person's claim for compensation if he or she was partially responsible for the incident. Workers compensation does not take the employee's negligence into account. 

For example, if an employee develops severe back pain related to sitting at a computer all day, he or she is still eligible for compensation even if posture was a contributing factor. If the employee has to climb stairs to accomplish a task, becomes distracted by something in view and trips, workers comp payments still should be made. 

Intentional or Reckless Behavior

The situation changes if the employee was injured because of intentional or reckless behavior, including activity that is prohibited by the employer. For example, an employee who trips and falls down at work after drinking alcohol at lunchtime may have problems getting workers compensation payments. An employee who shows off to co-workers by standing on a moving forklift and then falls off also may have trouble getting compensation.

However, an employee who disregards a sign that warns of a wet floor because he or she is a hurry and then slips and falls may still be eligible for workers compensation. The behavior may not have been a smart choice, but it probably won't be viewed as reckless with a complete disregard for safety.

What Can You Do Now?

Contact a workers compensation lawyer to explain your situation and to learn whether you have a good case. You probably won't need to pay any upfront fees if you hire this attorney; instead, he or she will receive a percentage of your compensation that you agree on in your contract. 

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