Can You Get Workers' Comp If You Were At Fault for the Accident?
Many injured employees hesitate to file a claim because they believe doing something careless—like tripping while looking at their phone or misusing a tool—disqualifies them. In North Carolina, that is a misconception.
North Carolina’s Workers’ Compensation Act is structured as a “no-fault” compromise:
What Employers Give Up: Employers cannot deny benefits simply because an employee made a mistake, acted carelessly, or caused their own injury.
What Employees Give Up: Employees cannot sue their employer in civil court for non-economic damages like “pain and suffering.”
Because the system is designed to provide prompt medical treatment and partial wage replacement without months of litigation over blame, carelessness or simple mistakes will not disqualify you from benefits.
Exceptions to the No-Fault Rule
While general fault does not disqualify you, specific legal exceptions apply:
Safety Violation Reductions (10% Penalty): If an employee willfully violates a known, enforced safety rule, the Industrial Commission may reduce weekly indemnity benefits by 10%.
OSHA Violations (10% Step-Up): Conversely, if an employer is cited for an OSHA safety violation related to the injury, the injured worker’s weekly indemnity benefits may be increased by 10%.
“Woodson” Claims: If an employer engages in misconduct so severe that it was substantially certain to cause serious injury or death (e.g., ordering workers into an unbraced, dangerous trench), the injured worker may be allowed to bypass workers’ comp and file a civil lawsuit directly against the employer.
Disqualifying Factors That Can Lead to a Denied Claim
Some denials are based on the injured worker’s conduct at the time of the accident. These are among the most common legal grounds for disqualification:
Intoxication or Drug Use
If you were under the influence of alcohol or an illegal drug when injured, your claim may be denied. To disqualify you, your employer must prove:
- You were impaired
- The impairment caused or contributed to your injury
A failed post-accident drug or alcohol test creates a rebuttable presumption of impairment. This shifts the legal burden to you to prove that the substance did not cause or contribute to the crash or injury.
Willful Misconduct or Reckless Behavior
Workers’ comp can be denied or reduced (by up to 10%) if the injury was caused by:
- Intentional self-harm or violence toward others
- Horseplay, roughhousing, or unsafe behavior
- Violating known safety rules
- Refusing to use required safety equipment
If your actions show a disregard for workplace safety, your claim could be reduced—or denied altogether.
Was Your Injury Work-Related?
To qualify for benefits, an injury must arise “out of and in the course of employment.” If an injury occurs while you are performing personal activities, your claim will likely be disqualified.
The "Coming and Going" Rule for Travel & Commutes
As a general rule, injuries suffered while commuting to or from your regular workplace are not covered by workers’ compensation. Under the “coming and going rule,” a standard daily commute is considered a personal activity rather than a work duty.
Key Exceptions for Travel Injuries
You can receive workers’ comp for travel-related injuries if you meet one of the following exceptions:
Company Vehicles & Travel Reimbursement: You were driving an employer-owned vehicle or your employer was reimbursing you for gas/mileage at the time of the crash.
Multiple Job Locations / Traveling Employees: Workers who do not report to the same office every day—such as construction framers, home healthcare aides, or field service technicians—are typically covered during their transit between sites.
Out-of-Town Business Trips: If you are traveling out of town for business, your entire trip (including staying at a hotel or dining out) is generally considered “on the job.”
Technical Reasons Claims Get Denied
Not all denials are based on behavior. Many claims are denied for procedural or coverage-related reasons, including:
Missed Deadlines
Missing a state-mandated deadline is one of the most common reasons workers’ comp claims are denied. North Carolina law requires you to:
- Notify your employer in writing within 30 days of the injury
- File Form 18 with the North Carolina Industrial Commission within two years
Failure to meet either deadline may result in disqualification.
Employer Doesn’t Carry Coverage
In North Carolina, any business that regularly employs three or more employees is required to maintain coverage under North Carolina Department of Insurance workers’ compensation guidelines. If an uninsured employer illegally fails to carry insurance, you may still seek recovery through specific state funds or direct legal claims against the business owner.
Misclassification as an Independent Contractor
Only legal employees qualify for workers’ compensation. Independent contractors are excluded. However, some employers illegally misclassify workers as “1099 contractors” to avoid paying insurance premiums. If your employer controls your work hours, equipment, and daily duties, you may legally be an employee regardless of your job title or tax form.
What To Do if Your Workers’ Compensation Claim Is Denied
If your claim has been denied—whether for misconduct, technical issues, or an insurance company’s bad faith—you still have options. Here’s what to do:
- Don’t assume the denial is final: Many denials are made in error.
- Request a copy of the denial explanation: This will clarify the reason.
- File an Appeal with the Industrial Commission: You have the right to request a formal hearing before a Deputy Commissioner by filing a Form 33.
- Contact a workers’ compensation attorney: A lawyer can review your case, gather evidence, and represent you in an appeal.
Promptly appealing the denial, gathering supporting medical evidence, and consulting a workers’ compensation lawyer can increase your chances of reversing the denial and securing the benefits you’re entitled to.
How Riddle & Riddle Injury Lawyers Can Help
Challenging a denied workers’ compensation claim or navigating gray-area travel injuries requires aggressive legal representation. At Riddle & Riddle Injury Lawyers, our work injury team is led by Attorney Adam Smith, a Board-Certified Specialist in Workers’ Compensation Law recognized by the North Carolina State Bar.
With over 171 years of combined legal experience, our firm has recovered hundreds of millions of dollars* for injured workers across North Carolina (see disclaimer below), including:
$2,475,000 for a construction worker who suffered a traumatic brain injury in a platform fall.
$1,700,000 for a truck driver who lost a leg following a severe crash on the job.
$829,000 for a worker injured by a falling tree while scouting job sites.
For more information, contact Riddle & Riddle Injury Lawyers to schedule a free consultation with a workers’ compensation lawyer in North Carolina today. We have twelve convenient locations in North Carolina, including Greenville, Raleigh, Goldsboro, Jacksonville, Kinston, Charlotte, Greensboro, Durham, Fayetteville, Wilmington, Winston-Salem & Garner.
