Overcoming Defenses in Workers’ Compensation Matters
Generally, workers’ compensation benefits, mostly medical bill payment and lost wage replacement, are no-fault benefits. Victims must only prove their illnesses or injuries were work-related to obtain full benefits. However, a few limited defenses apply in a few cases. Insurance company lawyers stretch these defenses as far as possible and use them as an excuse to reduce or deny benefits.
Once upon a time, defenses didn’t matter too much. The workers’ compensation bureaucracy was slanted toward job injury victims. Things are different today. Insurance company interests dominate this bureaucracy. Additionally, years of premium reductions have drained money from the system, making insurance companies even stingier. Because of this environment, a job injury victim needs a determined Tampa workers’ compensation lawyer.
Not Work-Related
Workers’ compensation benefits are unavailable if a pre-existing or non-work condition substantially caused the claimed illness or injury.
Assume Bill hurt his knee playing high school football. He still wears a knee sleeve. If he falls at work and hurts his knee, the insurance company will most likely claim that the work injury aggravated his pre-existing condition, and therefore benefits are unavailable.
So, a Tampa workers’ compensation lawyer must prove the pre-existing injury increased the risk and/or severity of a work-related injury. Expert medical testimony, generally from an independent medical examination, is necessary to establish this point.
Or, assume Joe is a smoker. Over time, he continually inhales trace amounts of toxic particles that result in lung cancer. Once again, his lawyer must prove that smoking increased the risk and/or severity of work-related cancer, not the other way around.
Under the Influence of a Substance
This defense usually only applies in falls and other trauma injury cases. Generally, workers’ compensation benefits are unavailable if the applicant was under the influence of alcohol or another substance at the time of injury. For this reason, most workers’ compensation policies require applicants to take immediate drug tests.
People may have drugs in their systems yet not be under the influence of that substance. Marijuana is a good example. THC hits most people like a ton of bricks. Then, the effect quickly and sharply fades. Additionally, there is no scientific consensus as to what level of THC establishes “under the influence.”
Additionally, drug tests often have technical issues. The people who evaluate these drug tests are often low-level technicians. Testimony from a degreed scientist almost always trumps technician results. Moreover, work-related drug tests often have chain-of-custody issues. The sample must go from an independent lab to the employer. The control change creates documentation issues.
Horseplay
If horseplay causes an injury or illness, once again in most cases, workers’ compensation benefits are unavailable. Legally, this defense only applies if the horseplay was completely unrelated to job duties.
Assume Bill and Joe race each other as they clean up their work areas at the end of the day. Since Joe rushes his work, he slips and falls.
By most definitions, Bill and Joe’s antics were horseplay. But since they weren’t completely unrelated to their job duties, their antics, while certainly unwise, do not create a legal obstacle to workers’ compensation benefits.
Count on a Dedicated Hillsborough County Lawyer
Injury victims are entitled to important financial benefits. For a confidential consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. Virtual, home, and hospital visits are available.
Source:
pieinsurance.com/blog/workers-comp/why-are-workers-comp-laws-called-no-fault-laws
