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The Influence of Workers Fault on Workers’ Compensation Eligibility

On Behalf of | Dec 11, 2023 | Workers' Compensation

The obligation to carry workers’ compensation insurance is owed by most employers in Illinois, which requires coverage for all employees on their staff. Part-time workers are also be eligible for benefits, regardless of their age or position, so long as they are employees of the company, and not independent contractors.

However, if an employee sustains a major injury and files a  workers’ compensation claim against their employer, the business can suffer major financial setbacks as a result. Accordingly, in an attempt to avoid substantial liability costs, these businesses should try to predict scenarios wherein a worker’s actions have a direct impact on their eligibility for benefits. Employers who are aware of the unusual circumstances surrounding a worker’s injury may want to evaluate the situation carefully to determine whether or not the worker technically qualifies for workers’ compensation benefits.

Despite the no-fault coverage provided by workers’ compensation insurance, there are at least three scenarios worth considering in which a worker’s actions and/or behavior may result in ineligibility for benefits.

Injuries Caused by Chemical Impairment

Many employers operate drug-free workplaces to keep their workers safe, in compliance with both state and federal laws. When a worker is injured and files a claim, drug and alcohol tests may be conducted for the purpose of determining the cause of such injuries. If the worker fails the test, these findings suggest that intoxication actually caused their injuries, potentially impacting their eligibility for benefits.

It is vital that employers act progressively and ultimately aim towards avoiding scenarios like this from arising in the first place. In order to operate and maintain a substance-free workplace, employers should establish regular drug and alcohol testing policies, as allowed under applicable state law, and conduct frequent testing to ensure that the workplace remains a safe environment for all employees.

Injuries as a Result of Law- or Rule-Breaking

It is standard practice for employers to put in place clear company policies, which employees are required to oblige by, in order to both limit the company’s liability and protect the company’s employees. A worker may be ineligible for workers’ compensation benefits when they intentionally violate a company policy and get hurt as a result. Similarly, if a worker intentionally broke the law while working and is injured due to same, that could also impact their right to benefits.

Businesses can be proactive in preventing these types of situations by establishing a strong corporate structure. This means ensuring up-to-date internal policies and procedures and enforcing such policies and procedures through mandatory and routine training for all employees.

Injuries Worsened Due to Medical Non-Compliance

Illinois workers’ compensation benefits provide coverage to pay for a an injured employee’s medical treatment, as well as benefits to replace most of the wages they lose while unable to work. Once a doctor has determined the appropriate course of treatment, it is imperative that the worker follow the doctor’s instructions. In the event that an employee refuses treatment or fails to comply with medical instructions, their future actions can worsen the condition of their injuries and ultimately lead to a need for more medical care and a longer leave of absence from their job. An employee’s culpability for the progression of their condition may have an impact on their eligibility for workers’ compensation benefits.

Employers can help limit their liabilities by establishing policies and procedures for their employees to follow in the event that an injury occurs, requiring employees to report medical instructions and restrictions that may impact their job duties and overall work performance, ultimately protecting both the employee from aggravating their present conditions or sustaining further injury.

Employers should practice due diligence in responding properly to an injury that occurred within the workplace. This can include establishing an Accident Review Board, procedures for investigating workplace-incidents, and enforcing up-to-date policies and employment training programs. With a strong corporate structure in place, businesses investigating situations that led to an injury in the workplace will be able to easily evaluate whether or not workers’ compensation will apply.

Fortunately, Arnett Law Group, LLC offers a variety of services that can cater to all your business’ needs in order to in minimize liability and to ensure that your business is prepared in the event that an employee gets injured in the workplace. Contact our office at (312) 561-5660 for more information or review our website at


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