Five Common Workers’ Compensation Defenses

Typically, workers’ compensation claims are no-fault matters. If an illness or injury is work-related, full benefits are available, even if the victim was partially at fault, or entirely at fault, for that injury. However, over the years, Florida judges and lawmakers have watered down the no-fault rule. Today, a handful of defenses are available in these cases. Additionally, in all job injury matters, insurance companies usually dispute the amount of damages (financial benefits). But that’s the subject of another blog.

A good Tampa workers’ compensation attorney knows that, despite the no-fault rule, insurance companies never roll over and play dead. During initial consultations, attorneys ask probing questions about these defenses and follow-up with thorough investigations. So, if the matter proceeds to an Administrative Law Judge appeal hearing, and it probably will, an attorney is prepared to refute these defenses with solid evidence.

Statute of Limitations

Normally, job injury victims must  bring legal claims within two years of the date of injury, or they lose the right to obtain benefits.

These benefits usually include lost wage replacement and medical bill payment. Usually, the victim’s AWW (average weekly wage) determines the lost wage benefit. Claimed medical expenses must be reasonably necessary.

Many occupational diseases, such as toxic exposure cancer, develop slowly over time. When victims discover their injuries, the two-year deadline has passed.

Usually, if they work with a Tampa workers’ compensation lawyer, these victims still get their day in court. Several SOL exceptions apply in these cases.

AMA (Against Medical Advice)

Some job injury victims don’t take their medicine, skip doctors’ appointments, and otherwise don’t follow their doctors’ orders. These victims may not be entitled to benefits.

AMA is usually justified. Many people don’t take medicine because it makes them sick or don’t keep doctors’ appointments because they have other, more pressing matters to attend to at that time.

Horseplay

If, at the time of injury, the victim was behaving recklessly, not following safety rules, or otherwise goofing off, benefits may be unavailable.

The horseplay must be unrelated to the job. If Jan and Dean race each other to see who can clean up their work areas first, from a legal perspective, that reckless conduct is not horseplay.

Fraud

This defense is basically the anti-AMA defense. A handful of workers stage injuries or inflate their medical bills. Many people believe workers’ compensation fraud is widespread, but according to most estimates, less than 1 percent of workers’ compensation claims are fraudulent.

Alcohol/Drug Use

We close this post with perhaps the most common workers’ compensation injury defense in Florida. Benefits are usually unavailable if, at the time of injury, the victim was under the influence of alcohol and/or drugs.

Most insurance companies rely on hospital blood tests to establish this defense. Usually, the hospital sends a blood sample to an offsite lab, often several days after the sample is extracted. This process raises chain of custody problems as well as sample integrity issues.

Usually, insurance companies fall back on circumstantial evidence, such as erratic behavior prior to the injury. Granted, intoxicated people behave erratically. But many other conditions, such as fatigue, inexperience (I don’t know how to do this job), or even clumsiness, could cause such behavior.

 Count on a Thorough Hillsborough County Attorney

Injury victims are entitled to important financial benefits. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. We do not charge upfront legal fees in these matters.