Common Defenses Against Workers’ Compensation Claims
As a business owner in the construction industry, it’s incredibly important to be aware of all of Florida’s workers’ compensation requirements. Any construction employer who has one or more employees, including any non-exempt business owner, is required to obtain workers’ insurance. Essentially, our state makes use of what is known as a no-fault system, in which employees can receive prompt delivery of medical benefits, and employers may protect their business from potential lawsuits.
While the system does not require that the employee demonstrate they were not at fault for the accident to receive workers’ compensation benefits, you do have a right as the employer to deny the claim. In today’s article, we’ll review just a few of the common defenses employers in the State of Florida use to defend their business against workers’ compensation claims.
The Employee Was Under the Influence of Drugs or Alcohol
This is by far the easiest defense to workers’ compensation claims. If you can prove that your employee was under the influence of drugs or alcohol at the time of injury, then you do not have to provide workers’ compensation benefits to that employee under Florida workers’ compensation law. To provide evidence that the worker was under the influence, it’s recommended that you either have medical tests performed immediately to find out whether or not they had drugs or alcohol in their system or acquire witness accounts from the jobsite. Someone doesn’t necessarily have to see the employee taking drugs or drinking alcohol, although that would be helpful, as witness accounts of erratic behavior, such as slurring their words or a glazed look in their eyes, could easily serve as valuable evidence.
The Injury Was Self-Inflicted
While most workers in Florida have valid workers’ compensation claims, it’s not unheard of for workers to intentionally injury themselves to receive workers’ compensation benefits. If you’re able to prove that the employee intentionally harmed themselves in an attempt to file a fraudulent claim and pad their pockets with workers’ compensation money, you have the right to deny benefits altogether.
Related: Workers’ Compensation Defense Tips
Willful Negligence or Horseplay Occurred
If the employee was displaying reckless behavior at the time of the injury, engaged in misconduct, did not adhere to safety rules, or was otherwise injured as a result of goofing off or being careless, you may be able to argue against the employee’s workers’ compensation claim on the basis of willful negligence or horseplay.
The Injury Cannot Be Linked to Employment
It should go without saying that unless the injury or illness can be linked to activities within the course and scope of the employee’s work, the employee cannot be eligible for workers’ compensation benefits. This goes beyond whether or not the worker was clocked in at the time of the injury as they could have been performing an activity related to his or her work at any location. There simply needs to be proof that the injury was linked to activities relevant to their employment. You can use this defense in circumstances in which the employee was engaging in activities outside of the scope of work.
The Employee Did Not Attend Doctor Appointments
An important part of a workers’ compensation claim is the independent medical examination required to determine the amount of benefits and verify the claim. If your employee did not attend his or her doctor appointment or otherwise refused medical treatment, then you have the right to withhold workers’ compensation benefits. This action may also result in the reduction of said employee’s workers’ compensation claim. It is the responsibility of the injured employee to show up to any appointments, comply with medical recommendations, and attend any other evaluations as scheduled by his or her insurance carrier.
The Employee Failed to File His or Her Claim Within the Statute of Limitations
Last but certainly not least, there is the statute of limitations. Each state has a time limit in which the employee must file their workers’ compensation claim in order to receive benefits. In the State of Florida, employees have two years from the date of injury to exercise their right to receive medical treatment, claim benefits, or sue for lost wages. This timeframe does not begin to run, however, until the injured employee knows or should have recognized the nature of his or her injury or disease. In most circumstances, the timeline for the statute of limitations ends up running from the date of the actual injury.
That being said, exceptions to this statute of limitations do exist. If you misled the employee about their entitlement to workers’ compensation, the worker is mentally incompetent, or the carrier failed to inform the injured employee of his or her rights, then the statute of limitations may not necessarily apply. To ensure you have a good understanding of any and all laws and regulations related to workers’ compensation in Florida and are equipped with high-quality legal representation should you be presented with a workers’ compensation claim, don’t hesitate to contact a Florida construction attorney.
If you would like to speak with one of our Florida construction attorneys, please contact us today.
Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.