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How Can Workers’ Compensation Insurance Deny My Claim If I Was Injured

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NH Workers’ Compensation – An employee is not entitled to workers’ compensation benefits just because the employee’s injury occurs at work.  In order to be entitled to workers’ compensation benefits, the employee must show that her injuries arose out of and in the course of her employment.  The requirement that an injury must arise out of work means the employee must prove that the injury resulted from a risk created by the employment.

Under New Hampshire law, there are four (4) classifications of injury-causing risks encountered by an employee at work: (1) risks directly associated with employment; (2) risks personal to the employee (3) mixed risks; and (4) neutral risks.  If the employee’s injury results from an employment-related risk, the employee will satisfy the requirement that the injury arose out of employment.  The employee cannot satisfy this requirement if a risk personal to the employee caused the injury.

What Are Mixed Risks?

What about mixed risks?  Mixed risks involve a personal risk and an employment risk combining to produce injury.  An employee with heart disease who dies after suffering an employment-related strain on the heart exhibits an injury resulting from a mixed risk.  An injury resulting from a mixed risk will only qualify for workers’ compensation benefits if the employee can prove that his employment was a substantial contributing factor to the injury.

What Are Neutral Risks?

The New Hampshire Supreme Court just handed down a decision addressing neutral risks on November 2, 2018.  In the Appeal of Sirles, the employee fell down steps while at work and injured her hand.  The cause of the employee’s fall was unexplained.  The New Hampshire Department of Labor denied the employee’s claim for workers’ compensation benefits, finding no causal relationship between the injury and employment.

The Supreme Court vacated the Department of Labor’s decision.  The Supreme Court reasoned that an unexplained fall results from a neutral risk—a situation in which the cause of the employee’s injury, or the nature of the cause, is simply unknown.  Where an injury results from a neutral risk, the employee may be entitled to workers’ compensation benefits if the employee satisfies the “increased risk” test—if the employee shows that her employer subjected her to an increased quantity of risk of suffering the injury.  In Sirles, the employee presented evidence that her job duties required her to walk up and downstairs “constantly,” and that the stairs down which she fell failed to comply with the applicable building code.  Because the Department of Labor failed to address the “increased risk” test in denying the employee’s claim, the Supreme Court sent the case back to the Department of Labor for the Department to apply the “increased risk” test.

If you need assistance with a workers’ compensation claim, you should consult an attorney experienced in representing employees in workers’ compensation cases such as Benjamin T. King, Esquire, of Douglas, Leonard & Garvey, P.C.  Attorney King has been listed in Best Lawyers in America in 2017 and 2018 for representing employees in workers’ compensation matters.  You can reach Attorney King at (603) 288-1403 or fill out our online contact form.