Injured during lunch? Your workers’ comp claim could be denied

The last blog post discussed whether employees in the state of California injured during rest periods or lunch breaks were covered under workers’ compensation laws and entitled to benefits.

Generally speaking—the answer is yes.

Rest periods are part of the course of employment and the courts have stated that those who opt to take their lunch or breaks on company property are entitled to medical benefits, rehabilitation expenses, lost wages, and other benefits under California’s workers’ comp laws if they are injured.

However, like most rules, there are always exceptions, limitations and exclusions to a general point of law.

The caveat – illegal or intentional acts

In this situation, workers may be entitled to benefits if they were injured while eating lunch on company premises, but they could be disqualified from receiving workers’ comp if the injury was:

• Due to alcohol intoxication
• Due to impairment from a narcotic or controlled substance
• Self-inflicted
• An intentional act, such as an altercation with another employee

Your rights

It is important to understand that, even if any of the above occurred during your lunch or rest break at work, it does not necessarily mean you as an employee will never recover benefits. It is important not to give up on your claim. Insurance companies often deny workers’ compensation claims, but these entities do not have the ultimate say.

You are entitled to a hearing

Like many states, there is typically a procedure involved for workers’ comp claims that have been denied by an insurance entity or an administrative law judge.

Employees (referred to as applicants) in the state of California who are denied benefits can apply for reconsideration. A hearing, very much like an informal trial, before the Workers’ Compensation Appeals Board (WCAB) will be conducted. The Board, made up of seven members, will review and reconsider the denial after the parties have an opportunity to discuss the situation, issues and facts in greater detail.

Representation during your hearing is essential

California workers are not encouraged to handle this proceeding alone without assistance. There are complicated rules, specific procedures and strict deadlines that must be met. Failing to follow the right protocols could bar you from review or recovery.

An experienced workers’ compensation lawyer who knows the laws and procedures involved with these cases should be present to act as your advocate. A legal professional who has handled such instances before is likely to substantially increase your chances of success.