Workers' compensation claims may be denied for various reasons. Sometimes, it is because the injury did not arise out of your job. Other times, it may be clear the accident happened on the job, but the claim was denied because you were engaged in illegal or improper conduct at the time you were injured.
Under Georgia law, workers' compensation benefits (money and medical care) will be denied if the employee's injury or death arose from the employee's willful misconduct, including intentionally self-inflicted injuries, injuries which arose from the employee's attempt to injure another or injuries which arose from the willful failure to use a safety appliance or to perform a duty required by statute.
Benefits may also be denied if the employee was engaged in horseplay at the time he or she was injured or if the injury was due to the employee being intoxicated by alcohol, marijuana or a controlled substance at the time of the accident. Your employer may require a drug or alcohol test if you report a work related injury.
Benefits may also be denied if you fail to disclose a pre-existing condition when you were hired and you were later injured and became disabled due in part to the pre-existing condition. However, this duty to disclose prior conditions will only arise if you were questioned about prior conditions by your employer at time of hire or in a pre-employment physical. For example, if you begin work for a new employer while under restrictions from recent back surgery and fail to disclose this condition in a pre-employment physical when questioned about pre-existing conditions, your claim for benefits will most likely be barred if you later aggravate your back condition while working at your new job.
Questions
Q1. While working, my supervisor and I had an argument about work. He punched me, knocked me down and injured my back. Am I covered?
Yes. If a co-employee or supervisor injures you in an attack at work and the attack arose out of some dispute related to the job, your injuries are covered under workers' comp. You are prohibited from suing the individual who attacked you, but you can take out an arrest warrant on the attacker. If instead the assault is due to a personal dispute unrelated to your job, it does not arise out of your employment and your claim will most likely be denied.
Q2. I was at a party last week and smoked some pot. This week while driving a forklift at work I lost control of the forklift, crashed into some boxes and injured my back. I was given a drug test and it came back positive for marijuana. The employer denied my claim, even though I was not intoxicated at the time of the accident. Do I have a claim for benefits?
If you test positive for marijuana or other controlled substance pursuant to a drug test taken within eight hours of an accident, or positive for alcohol pursuant to a test taken within three hours of an accident, it will be presumed your injury was caused by intoxication and you will have the burden of proving you were not intoxicated at the time of the injury. If you cannot disprove you were intoxicated, your claim will be denied.
Q3. What if I refuse to take a drug or alcohol test immediately following a work accident?
Unjustifiably refusing to submit to the drug or alcohol test has the same effect as testing positive for drugs or alcohol. You will be faced with the presumption you were intoxicated and the intoxication led to your accident. You will have the burden to prove you were not intoxicated.
Q4. My employer denied my workers' compensation benefits because I violated a safety rule which led to an accident and my injury. Do I have a claim?
Yes. Failure to follow a safety rule is not a defense to workers' comp claims. The system is a no-fault system. Even if you violated job rules or your own negligence caused the accident, you are entitled to benefits.
