Workers’ Compensation Reasons for Denial

Even if you can prove that you were injured at work and you can document your injury with medical evidence, your employer and the work comp insurance carrier may continue to deny your claim based upon a wide array of defenses. These defenses include failure to provide employment services, horseplay, intoxication, idiopathic falls, and independent contractor. We have been successful litigating cases involving each one of these issues.

Failure to Provide Employment Services

Employers and insurance carriers often deny claims alleging employees were not providing employment services at the time of the injury. The courts determine whether the injury occurred within the time and space boundaries of the employment, when the employee was carrying out the employer’s purpose or advancing the employer’s interest, directly or indirectly.

  • In Barrett v. C.L. Swanson Corp., 2010 Ark. App. 91, (2010), we were successful in obtaining a client work comp benefits even after she had clocked out at the end of her shift, because we proved she was continuing to advance the employer’s interest even after she had clocked out. My client had been employed for over nine years with the employer as a manager and frequently worked off the clock prior to her injury. At the time of her injury, she tripped on a rug and fell at her employer’s premises, she was engaged in a work discussion and in the process of checking the office fax machine. The Arkansas Court of Appeals reversed the Work comp commission’s denial of benefits and held that checking the mailbox and fax machine at the end of the day advanced employer’s interests despite doing these things while clocked out.

Horseplay

When employees are injured while engaging in horseplay, their claim can be denied. We have been successful proving that a worker’s fatal injury occurred when he was beaten to death on the job. To prevail in this defense, the employer must prove that the injured worker was an active participant in the horseplay.

  • In Maria Barron, Widow of Miguel Barron, v. West Ark Steel and AIG, WCC No. F800250 (2010), the Workers’ Compensation Commission held that Claimant, a welder, attempted to break up an altercation between co-workers without raising his fists. The Commission held that the deceased worker was performing employment service by attempting to break up the altercation and was not an active participant in the altercation based upon the testimony of multiple eyewitnesses.

Intoxication

A positive drug or alcohol test can also be a defense in which employers and insurance carriers can deny work comp injuries. Arkansas law states that a compensable work comp injury does not include injuries where the accident was substantially occasioned by the use of alcohol or marijuana. Arkansas law goes on to state that the presence of alcohol or the illegal drug creates a rebuttable presumption that the accident or injury was substantially occasioned by the alcohol or illegal substance. It then becomes the employee’s burden to prove the positive drug or alcohol test did not cause the accident or injury. The recent amendment to the Arkansas Constitution allowing marijuana to be prescribed for medical purposes has yet to be addressed by the courts, but it will certainly impact future decisions.

  • The insurance carrier in the above-mentioned Barron case, Maria Barron, Widow of Miguel Barron, v. West Ark Steel and AIG, WCC No. F800250 (2010), also alleged a defense of alcohol intoxication in the fatal injury of Miguel Barron. We were able to rebut the presumption in that intoxication had nothing to do with the fatal injury sustained by Barron. Claimant’s death had nothing to do with lack of judgement or physical impairment, instead, claimant was punched three times in the face by his supervisor, was knocked unconscious, and his head hit the concrete floor resulting in his fatal brain injury. The Work Comp Commission found that we put on evidence successfully rebutting the presumption.

Idiopathic Fall

An idiopathic fall is one whose cause is personal in nature, or peculiar to the injured worker, and because an idiopathic fall is not related to employment, it is generally not compensable under workers’ compensation law unless conditions related to employment contribute to the risk by placing the employee in a position, which increases the dangerous effect of the fall. These cases can become extremely complicated and are often confused with injuries which occur from unexplained falls. When a truly unexplained fall occurs while the employee is on the job and performing the duties of her employment, the injury resulting therefrom is compensable under workers’ compensation law.

  • In Walker v. City of Alma and Municipal League, WCC G705468 (2017), we were successful in arguing that a client’s shoulder and neck injuries were compensable after the worker became dizzy after picking up trash from a trail and fell over a wall. We successfully argued that the positional risk doctrine came into play as the injured worker was injured while working at a height that placed him in significant risk of injury.

An injury is deemed to arise out of the employment under the positional-risk doctrine, for workers’ compensation purposes, if it is one that would not have occurred but for the fact that the conditions and obligations of the employment placed the claimant in the position where the injury occurred.

Independent Contractor

Employers continue to attempt to avoid work comp insurance and premiums arguing that their workers are independent contractors and not employees. This puts insurance carriers in a precarious position, since they have not received insurance premiums for the injured worker but the facts may indicate that coverage should be applied. We have been successful litigating these cases which we frequently see in both the trucking and the construction industries.

The work comp commission considers two separate tests to determine whether or not a worker is an employee covered by workers’ compensation or an independent contractor which is not covered by work comp insurance. Those two tests are the 1) Control Test and 2) Relative Nature of the Work Test.

  1. Under the Control Test the work comp commission determines if the employer maintains control of the means and manner of the work as wells as the result of the work. If the employer controls both, then the worker is deemed to be an employee.
  2. However, if the control of the work is unclear, then the work comp commission looks at ten factors outlined in the Relative Nature of the Work Test. Those ten factors are:
  1. The extent of control the employer may exert of the details of the work,
  2. Whether or not the worker is engaged in a distinct occupation or business,
  3. The kind of occupation and whether or not the work is typically performed under the direction of an employer,
  4. The skill required in the occupation,
  5. Whether or not the employer provides the tools, supplies and location of the work,
  6. The length of time of the employment,
  7. The method of payment, by job or by time,
  8. Whether or not the work is part of the regular business of the employer,
  9. Whether or not the parties involved believe they are creating an employment relationship, and
  10. Whether or not the employer is in business.

The Law Office of Jason M. Hatfield, P.A. has successfully litigated and won many of these cases. Below is an example of case we litigated and won.

  • In Rosales v. Elite Masonry and First Comp Insurance, WCC No. G403930, we prevailed for a brick mason that was injured when several fingers from his dominant hand were amputated as a result of fall from some scaffolding. The employer failed to withhold taxes and required the injured worker to submit a certificate of non-insurance coverage. However, the work comp commission found it relevant that the employer was a masonry company and had to have masons to perform his business. Arkansas law has consistently held that the more a worker’s occupation resembles his employers, the more likely worker is an employee.

Springdale Workers’ Compensation Attorney

Experienced. Dedicated. Compassionate.

I have over 20 years of experience as a lawyer helping injured workers in Arkansas. It does not matter what type of injury you suffered on the job — you have worked long and hard to get where you are today.

If you find yourself in a situation where your employer or employer’s insurance carrier is using one of the above defenses to deny your workers’ compensation benefits or the insurance carrier requests to take your recorded statement you should immediately contact the Law Office of Jason M. Hatfield, P.A. at 479-361-3575.

The Law Office of Jason M. Hatfield, P.A. represents injured workers from all over Northwest Arkansas including Springdale, Fayetteville, Fort Smith, Rogers, Bentonville, Berryville and Harrison. We also represent injured truck drivers from all over the U.S. with employers, such as; J.B. Hunt Transport, Tyson Foods Inc., Walmart Inc., PAM Transport Inc., USA Truck Inc., Maverick Trucking and others in Arkansas.