As stated straightforwardly by the California Department of Industrial Relations (DIR), all employers in the state must comply with the statutory mandate to provide workers with no-fault workers’ compensation coverage. California workers’ compensation allows injured employees to recover benefits regardless of fault—but there is a strict exception for intentional or self-inflicted injuries. Here, our Salinas workers’ compensation defense attorney explains the most important things to know about defending a workers’ compensation claim on the grounds of an “intentionally self-inflicted” injury.
Background: Fault is Not a Factor in Workers’ Compensation Claims in California
As a starting point, it is important to emphasize that fault is not a determining factor in workers’ compensation claims in California. An employee who was hurt within the course and scope of his or her employment can file for workers’ compensation benefits regardless of whether or not their injury/illness was caused by employer negligence.
Limitation: Intentionally Self-Inflicted Injuries are Not Covered By Workers’ Compensation
As noted previously, work-relatedness is the key factor that will determine whether or not an injury or illness is covered by workers’ compensation insurance in California. Under state law (Cal. Lab. Code § 14300.5), there are guidelines in place for the determination of the work-relatedness of an injury, illness, or other medical impairment. The statutory language is clear: There is no workers’ compensation coverage for injuries that are “intentionally self-inflicted.” Workers cannot claim medical benefits or temporary disability benefits if they injured themselves on purpose.
A Complex Defense: Employer or Insurance Company Must Prove Deliberate Intent
While employers and insurers can defend a workers’ compensation claim on the grounds that an employee’s injuries were “intentionally self-inflicted”, it is important to clarify that this is not a negligence standard. An employee who causes their injuries through ordinary negligence—for example, if he or she was running where there was a clearly marked wet floor—can still recover workers’ compensation benefits in California.
To defend a workers’ compensation claim on the grounds of a self-inflicted injury, an employer or insurer must be prepared to prove deliberate intent. In other words, an employer or insurance carrier must present strong, compelling, and comprehensive evidence that indicates that the employee took deliberate and intentional steps to harm themselves on purpose. If an employee was not trying to cause an injury to himself or herself, then this workers’ compensation defense does not apply. Any party seeking to raise this workers’ compensation defense should proactively and thoroughly investigate the underlying incident. Evidence is key.
Schedule a Confidential Consultation With a Salinas Workers’ Compensation Defense Lawyer
At Yrulegui & Roberts, we provide proactive, solutions-centered guidance and support to employers, claim administrators, and insurance carriers. If you have any specific questions or concerns about defending a workers’ compensation claim on the grounds of an intentionally self-inflicted injury, we are here to help. Contact us today to schedule your strictly confidential consultation. We provide workers’ compensation defense representation throughout all of Central California.