If an employee is injured on the job, a workers’ compensation insurance claim is likely to follow. Whether the claim is accepted is another question. Some cases are particularly difficult to navigate. Claims can become particularly uncertain when the injury is caused by fight.
In New York, workers’ compensation insurance benefits are paid if the injury was sustained during work-related events, regardless of whether it was caused by the employee’s carelessness or the employer’s negligence. However, if it was caused solely due to the injured employee’s drug or alcohol use or attempt to injure someone, the claim is not compensable. In the case of a disputed claim, a judge determines the outcome.
Similarly, in New Jersey, workers’ compensation is paid if the injury occurred during job-related events as long as the employee was not willfully negligent. Section 34:15-7.1 states that if an employee is injured as a result of the “horseplay or skylarking” not instigated or participated in by the injured employee, the claim is compensable. Again, disputes are settled in court.
Unless the individual in question is a boxer or a bouncer, physical altercations are likely not part of the job description. A fight clearly falls outside of work-related tasks. However, if the fight occurs at work and with another employee or a customer, there is a clear connection to work.
The next issue concerns whether the employee sought to cause harm or acted in a willfully negligent way. Whether the injured employee was the instigator of the fight is important here. If the injured employee started the fight, it can easily be argued that the employee was trying to cause injury and acted with willful negligence.
If the injured employee did not start the physical altercation, the case may become more uncertain. Was the employee forced to defend himself? Or could the employee have avoided or ended the fight but decided instead to escalate the situation? Did the injured employee provoke the fight in any way? Was the fight itself personal or work-related in nature?
The Court Cases
To determine whether workers’ compensation insurance claims involving fights are compensable, it’s helpful to look at previous cases that have gone to court.
One recent case involved a fight between two workers in Louisiana. The first worker verbally insulted and threatened the second. The second worker hit the first. The first filed a claim, which went to court and was then appealed. The judge ruled that the claim was not compensable on the grounds that the verbal confrontation immediately preceding the fight proved the incident was personal, not work-related, in nature.
A previous case in New York had a similar result. In 2012, the New York Supreme Court denied a workers’ compensation claim involving a fight. The court ruled the fight was personal in nature and therefore not compensable.
Participation in a personal fight at work could cause a workers’ compensation claim to be denied. That said, there is no clear answer as to whether a workers’ compensation claim arising from a fight is compensable in general. The outcome will depend on the details of the case.