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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.

The San Francisco workers’ compensation attorneys at Allegiance Law understand these cases, and we know that employers and insurance carriers will use various excuses to deny claims. Sometimes, their denials are legitimate. Often, they are not. A skilled workers’ compensation attorney can help determine the difference between a legitimate denial and an illegitimate one.

Top Defenses An Employer In San Francisco May Use To Deny A Claim

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 defense is declared. Therefore, if your employer is asserting an affirmative defense in an 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).
  • Willful misconduct, “horseplay” or “skylarking” – “Horseplay” is typically considered to be roughhousing 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.

Time Limit To File A California Workers’ Compensation Claim

In California, work injuries must be reported to the employer within 30 days of the injury or illness occurring or within 30 days of being diagnosed with an injury or illness. However, simply reporting the injury to the employer does not mean that a workers’ compensation claim has been filed. The California statute of limitations for filing a workers’ compensation claim is one year from the date of the job-related injury or illness. Failing to file a claim within this one-year timeframe could result in the injury victim being unable to recover any compensation for their losses.

Contact Our San Francisco Workers’ Compensation Attorneys For A Free Consultation

If you have been injured at work and your employer has said that you are not going to be eligible to receive workers’ compensation benefits, that does not have to be the last word in the matter. At Allegiance Law, we have a thorough understanding of California work injury laws, and we have extensive experience representing injured employees. We will work to investigate your case and determine whether or not your claim should be accepted or denied.

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.