Workers’ compensation is a no-fault system that provides injured workers with medical cost coverage and wage loss benefits. It was designed to replace an inequitable prior system in which employees could only recover injury compensation if they could prove their employer’s negligence through a personal injury lawsuit. The advantage to workers’ comp is that benefits are payable even if the employer was not negligent and even if the employee was actually at fault for his or her own injuries. However, there are several situations in which an employee may not be entitled to compensation, even if he or she was injured on the job.
North Carolina’s Workers’ Compensation Act provides several exceptions to the general rule of coverage that NC workers enjoy including the following:
- If the injury was proximately caused by the worker being under the influence of alcohol or other controlled substances
- If the employee intentionally injured him or herself
- If the employee willfully misrepresented his or her physical condition during the hiring process, the employer relied upon that misrepresentation and there is a causal connection between the misrepresented physical condition and the employee’s injury
In addition to these more clearly defined exceptions, injuries suffered outside the course and scope of the employee’s employment may also be non-compensable, even if they occurred during working hours or on the employer’s premises. Unfortunately, the rules in this area are quite nuanced, and employers frequently try to stretch the bounds of this exception in order to escape accountability. If your North Carolina workers’ compensation claim has been denied, you should consult a knowledgeable attorney at once and review your legal options.