Intoxication and Workers Compensation Claims
As a rule, injured workers cannot collect Worker’s Compensation benefits if they contribute to their injury by consuming alcohol or drugs. In many states, intoxication acts as a complete bar to recovery, while in others a worker’s benefits may be reduced if he or she was intoxicated at the time an injury occurred. But in some states, including Illinois and Kentucky, a worker who was under the influence of drugs or alcohol at the time of an injury may still receive benefits unless the employer can prove that intoxication was the proximate primary cause of the worker’s injuries. In other words, it’s not enough for an employer to prove that an injured was intoxicated. It must also prove that the injury happened mainly because the person was under the influence of alcohol or drugs.
Intoxication Not Always a Defense
A recent case in Kentucky underscored this fact when an appellate court upheld the decision of the Kentucky Workers Compensation Board to grant workers compensation benefits to a man who tested positive for cocaine. The injured worker, Bernabe Aguirre, was working for a contractor on the construction of an H.H. Greg store when he fell off a ladder and broke his ankle and foot. When he sought treatment for his injuries, Aguirre submitted a urine sample to the health care provider, and the sample tested positive for metabolites of cocaine. Mr. Aguirre subsequently filed a workers compensation claim, which his employer, R&T Acoustics, denied. The denial was based on the employer’s claim that injury was “proximately caused primarily by voluntary intoxication,” which is a defense against a workers compensation claim according to Kentucky law. Mr. Aguirre claimed that the ladder slipped, causing him to fall.
An administrative law judge subsequently dismissed Aguirre’s claim based on a physician’s testimony that the presence of cocaine in Aguirre’s system “could undermine” his ability to safely perform his job. The physician further stated that the cocaine “could have been a significant contributing factor in his injury.”
However, another physician testified at the same hearing that there was no way to know if Mr. Aguirre was actually impaired at the time the injury occurred, stating that the cocaine may have been ingested the night before.
Aguirre appealed to the Workers Compensation Board, which vacated the original decision, stating that the employer had failed to demonstrate the Mr. Aguirre’s cocaine ingestion was the proximate, primary cause of his fall. The employer appealed, but the appellate court held that the administrative law judge erred in his decision because there was no direct evidence supporting the employer’s claim that the injury was directly or primarily caused by Aguirre’s “intoxicated” state. The employer’s claim that Aguille’s failure to provide an alternative scenario for the injury was proof that cocaine was at fault deemed insufficient on its face.
Documentation Is Key
In some states, a positive drug test may be all that’s needed to squash a workers compensation claim. But in those states that don’t provide clear statutory guidelines, resolution of disputed claims involving drugs or alcohol in the workplace typically fall to the courts. To prevail in such cases, the employer needs to carefully follow legal guidelines around the timing of drug testing to prevail. Additionally, it should document reports from co-workers or supervisors about the injured worker’s behavior prior to the event. As the Kentucky case shows, simply proving the presence of a drug in a worker’s system is not always sufficient to prove cause and effect.
The Carmoon Group, Ltd. is an independent insurance broker headquartered in Hicksville, New York. Through our large network of nationwide affiliates, we offer insurance and risk management solutions to businesses all across the United States. Our experienced professionals are standing by now to assist you with all of your needs. So give us a call today to schedule an appointment, or reach out online and we will get back to you at a convenient time.