What are Workers’ Compensation Willful Misconduct Claims?


When an employee is injured on the job, workers’ compensation insurance provides financial benefits and assistance with getting back to work. In some cases, however, a worker may intentionally disregard safety protocols or even the direct instructions of their supervisor, resulting in an accident that injures them. These instances are known as willful misconduct or willful negligence claims.

A claim of willful misconduct by a worker may be made when they act in a reckless manner that results in an injury. This can include doing something specifically prohibited by their employer or disregarding direct instructions from management. It might also occur if a worker falsifies documents, endangers others, or does anything that demonstrates the intentional disregard for the safety of themselves or others based on their understanding of the risks involved. Because these actions demonstrate a conscious disregard for the consequences of their behavior, many states have laws regarding workers’ compensation willful misconduct claims.

What Is Considered Willful Misconduct?

A willful misconduct claim is usually based on a single instance of an employee’s behavior. However, it’s possible for someone to have multiple willful misconduct claims. They can lead to a denial or reduction of workers’ compensation benefits, or even the denial of future claims.

Most employers have strict policies regarding willful misconduct and may seek to terminate an employee who is found to have engaged in such behavior. A few examples of willful misconduct include:

  • Intentionally ignoring safety protocols. This can include not wearing the appropriate safety gear, disobeying a direct order from a supervisor, or refusing to follow safety procedures in place to protect employees.
  • Intentionally disregarding a direct order from a supervisor. This includes failing to comply with a direct order from a supervisor, such as disregarding a request to stay on the job when injured.
  • Intentionally creating or contributing to the cause of an accident or injury.
  • Intentionally failing to report an incident that resulted in or could have resulted in an injury.
  • Failing to report the use of drugs or alcohol that could affect job performance.
  • Falsifying a document, including an accident report, medical documentation, or a claim for workers’ compensation.
  • Intentionally injuring others or failing to take reasonable measures to prevent harm that could befall others.

It’s important to note, however, that a worker’s willful misconduct can only be shown if the worker intentionally engaged in their behavior and there are no mitigating factors such as negligence, ignorance, or mistaken belief about the appropriate safety precautions.

How Is Willful Misconduct Determined?

Each state has different laws regarding how willfully misconduct is determined. It’s often based on a finding by a judge, but can also be decided by an administrative law judge, an insurance adjuster, or a hearing officer. In some cases, a worker may appeal a finding of willful misconduct, so the process may be more drawn out.  The determination of willful misconduct is often based on the facts of the situation. In some cases, it’s also determined by a worker’s intent at the time the incident occurred. For example, an accident caused by an employee who was not aware of the risks involved can be treated differently than one committed with awareness of the risks involved.

The following are examples of factors that may be considered when determining whether an incident was due to willful misconduct. It’s important to note that while these factors are common, they may not be used in every case. In some cases, it’s also possible that other factors may be taken into account.

  • The extent to which the incident was preventable
  • Whether the incident was caused by a single action or a series of actions
  • Whether the worker took appropriate steps to minimize the chance of injury
  • What the worker’s expectation was based on their knowledge of the situation
  • Whether the worker followed safety procedures
  • Whether the worker took any unnecessary risks
  • What the worker’s state of mind was at the time of the incident
  • Whether the worker falsified documents
  • Whether the worker violated the terms of their employment
  • Whether the worker was intoxicated or under the influence of drugs

Workers’ Compensation and Willful Misconduct

In some cases, an employee’s willful misconduct may result in an outright denial of workers’ compensation benefits. In others, the benefits may be reduced or taken away. In some cases, an employer may choose not to terminate an employee who has engaged in willful misconduct but may still penalize them by taking away the right to full workers’ compensation benefits. Depending on the situation, an employee may be able to receive workers’ compensation benefits even if they’re found to have engaged in willful misconduct. This may occur if the incident resulted in a minor injury or if the employee took reasonable steps to avoid the situation. In some cases, an employee’s willful misconduct may also result in a reduced amount of benefits. In some cases, it may result in a temporary denial of benefits.

Penalties for a Finding of Willful Misconduct

Depending on the extent of the willful misconduct, an employee may face fines and other penalties. In some cases, they may be charged with a criminal offense, such as fraud or assault. In others, they may be charged with a lesser offense, such as a misdemeanor or violation. An employee may also face a civil lawsuit from the employer if they’ve been injured as a result of their behavior. In some cases, other employees may also be able to file a lawsuit against the willful misconducting employee for damages.

Call to Get a Quote for Workers Compensation Insurance

The intention of workers’ compensation is to provide financial assistance to employees injured on the job. However, it’s important to remember that employees must follow the rules and procedures, including safety protocols, of the workplace. If an employee is found to have committed willful misconduct, they may lose the right to workers’ compensation benefits.

Millers Insurance Group provides workers compensation insurance to companies in a variety of industries, including cannabis-related businesses. Please reach out to us or fill out our online form to get an insurance quote today for your company’s workers compensation coverage.

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