In California, workers’ compensation law is a no-fault system. This means that benefits are available for the employee regardless of whether the injury was the fault of the employee or the fault of the employer. However, once it is determined that the injury did occur on the job, an employer may assert an affirmative defense that actions by the employee, which gave rise to their injury, are such that workers’ compensation benefits should be denied.
Whether or not the actions that the employee engaged in disqualifies him or her from receiving workers’ compensation benefits depends on several facts and factors. Each claim needs to be carefully evaluated because insurance companies, as a matter of routine, usually will deny the claim where a defense is declared. Therefore, if your employer is asserting an affirmative defense in attempt to bar your claim, it is imperative that you speak to an experienced workers’ compensation attorney right away.
An employer may attempt to assert one of the following defenses in order to bar your workers’ compensation benefits claim:
- Self-inflicted injury – Under California Labor Code § 3600(a)(5)-(6), an employee who intentionally injures himself or herself is not entitled to workers’ compensation benefits. However, the Court has distinguished between intentional acts to hurt oneself from impulsive acts. “Employees who merely act rashly or impulsively neither expect nor intend to necessarily hurt themselves nor are their resulting work-related injuries automatically noncompensable.” Smith v. Workers’ Comp. Appeals Bd., 94 Cal. Rptr. 2d 186, 193 (Ct. App. 2000).
The petitioner in Smith was a police officer that, while arguing with his superior, became upset and punched a wall, injuring his hand. The Workers’ Appeals Board barred the police officer’s claim based on the defense that the injury was intentionally self-inflicted. However, the Court of Appeals found that such a defense requires proof that the injured party had deliberate intent to injure oneself. As no proof was offered, the Court found that the police officer’s actions were an impulsive act, which is distinguishable from a deliberate intentional desire to injure oneself, and therefore he was entitled to workers’ compensation benefits.
- Willful misconduct, “horseplay” or “skylarking” – “Horseplay” is typically considered to be rough housing or boisterous play at work, while “skylarking” falls under trickery or jokes. Generally, injuries that result from an employee’s participation in “horseplay” or “skylarking” are not compensable through workers’ compensation. However, there is an exception to this rule. The Court has found that if there is convincing evidence that the employee’s horseplay or skylarking was customary at the workplace, known to the employer, and not objected to by the employer, then an injury that results is compensable. This is known as the “condonation” exception. See Argonaut Insurance Co. v. Workmen’s Comp. Appeals Bd., 247 Cal.App.2d 669 (1967), also see Hodges v. Workers’ Comp. Appeals Bd., 147 Cal. Rptr. 546, 552-53 (1978).
- Initial Physical Aggressor – Under California Labor Code §3600(a)(7), if an employee is an initial physical aggressor in an altercation at work and is injured, the injuries are not compensable under workers’ compensation. The actions of the other participants to the altercation, even if they increase the level of violence, do not absolve the initial aggressor. If the employee who is making a claim was the initial aggressor, the Court has reasoned that the employee then is the one that created the risk of injury in the first place, and therefore, the claim is barred. See Mathews vs. WCAB, (1972) 6 Cal.3d 719.
- Intoxication – Generally, per California Labor Code §3600(a)(4), injuries that are caused by intoxication (whether by alcohol or controlled substance) on the job are not compensable. However, in order for a claim to be barred, it must be shown that not only was the employee intoxicated but also that the intoxication was the proximate cause of the injury or a substantial factor in causing the injury. See Smith vs. WCAB, (1981) 123 Cal.App.3d 763.
If you were injured on the job and your employer has asserted an affirmative defense in an attempt to bar your claim, it is important to speak to our knowledgeable and skilled workers’ compensation attorneys.
Please contact us today for a FREE 30-minute consultation. Our workers’ compensation attorneys are available to meet with you during business hours, evenings, and weekends. Allegiance Law is located in San Francisco, but we will be happy to drive and meet you. You may contact Allegiance Law, at 415-404-6395. Or you may contact us by filling out the client inquiry form on this page.