Your employer’s insurance company may deny your workers’ compensation benefits under specific circumstances, such as:

• If you intentionally caused your injury or illness or 
• If it resulted from your willful misconduct. 

However, if your alleged impairment did not cause the accident, you have the right to request a hearing to challenge the denial, and our workers’ compensation lawyers can assist you in this process.

How Georgia Considers Injuries When a Worker is at Fault

The New York State Workers’ Compensation Board does not provide benefits to workers who are willfully or negligently at fault for causing their workplace accidents. There is a distinction between accidents that could happen to anyone in the same situation (covered by workers’ compensation) and accidents resulting from an employee’s willful misconduct or negligence (not covered by workers’ compensation).

Bad Acts That Could Squash Your Workers’ Compensation Eligibility

Certain bad acts can render a worker ineligible for workers’ compensation benefits. Examples include;

• Violating the employer’s code of conduct related to workplace safety
• Engaging in physical altercations with coworkers or superiors
• Working while intoxicated. 

Workers who become intoxicated through exposure to workplace chemicals or toxins may still be eligible for benefits, but those who are voluntarily intoxicated will likely be ineligible.

If you need further clarification or assistance with workers’ compensation eligibility guidelines, please don’t hesitate to contact our New York City workers’ compensation lawyers. 

Complete a free case evaluation form or call us at (212) 463-8888 today. 

If you’ve been injured at work and want to know if you’re eligible for workers’ compensation benefits, it’s crucial to consult a workers’ compensation lawyer who specializes in eligibility guidelines. They will provide legal assistance and ensure you understand the criteria for workers’ compensation in your specific situation.

In New York City, workers’ compensation eligibility can be complex, especially if you work for a small company or are unsure if your employer carries workers’ compensation insurance. Our team of experienced New York City workers’ compensation eligibility guidelines lawyers at Gabriel Legal Injury Lawyers can provide the answers you need.

Engaging In Horseplay In The Workplace

Participating in horseplay or initiating pranks can impact your eligibility for workers’ compensation benefits. If you were injured due to horseplay or a prank you started, you may be ineligible. However, if you were an unsuspecting victim of such activities, you are likely eligible for workers’ compensation benefits. In this case, the responsibility lies with your coworker rather than yourself.

Suffering Injury from Off-the-Clock Accidents

If you experience an accident while off the clock but still on the worksite, you might be ineligible for workers’ compensation. Typically, workers engaged in non-work-related activities during lunch breaks or smoke breaks are not covered. However, certain exceptions may apply, and our workers’ compensation eligibility lawyers can assess your situation to determine if you qualify for benefits.

Becoming Injured on the Clock but While Deviating from Your Normal Duties

Injuries sustained while deviating from your regular work duties may affect your eligibility for workers’ compensation. If you engage in activities outside the scope of your job without authorization and suffer an injury as a result, you may be ineligible for benefits. For instance, a delivery driver who makes a personal stop while on the clock and gets into an accident outside of their job duties may not be eligible for workers’ compensation benefits.

Other Factors That Could Affect Your Workers’ Compensation

In addition to the eligibility requirements discussed above, there are other factors that may influence your ability to collect benefits from your employer’s workers’ compensation plan.

Prompt Reporting: It is crucial to report any on-the-job accidents promptly to your supervisor. Failure to report your injury within 30 days may result in the loss of workers’ compensation benefits.

Choice of Medical Provider: New York State law mandates that employers provide a list of approved medical providers for treating work-related injuries or illnesses. You can choose from this list, which typically includes at least six physicians. Alternatively, you can contact a representative from the Workers’ Compensation Managed Care Organization contracted by your employer for medical services.

Working at a Lesser Paying Job: If your injury prevents you from returning to your previous position and you accept a lower-paying job, you may still be eligible for workers’ compensation. However, the benefits you receive will be reduced and should not exceed $450 per week. These benefits are limited to a maximum duration of 350 weeks from the date of your accident.

Catastrophic Injury: If you sustain a catastrophic injury, you may be eligible for lifetime benefits. For other types of injuries, benefits can be provided for up to 400 weeks.

Social Security Payments: It is possible to receive both Social Security and workers’ compensation simultaneously. However, receiving worker’s compensation benefits may affect the amount of your Social Security benefits.