Under the workers’ compensation bargain, the employer agrees to compensate an employee for any work-related injury or illness…unless the employee was engaged in a “prohibited act” at the time of injury.
A prohibited act is an act that the employer expressly prohibits—such as consuming alcohol or using other intoxicants while on the job or on the employer’s premises. When an employee conducts this act, the employee is considered to be outside the scope of employment, and therefore not protected by the employer’s workers’ compensation.
Sometimes it’s clear when the prohibited acts doctrine applies—as when a delivery employee is intoxicated and has a car wreck while on his scheduled delivery route. At other times, whether the doctrine applies or not can be a gray area. For example, if an employee on a weeklong business trip has an alcoholic drink, then trips and breaks her ankle, does the prohibited acts doctrine apply? That could depend on the circumstances—did the injury occur after normal work hours? Did the event occur while the employee was dining with a business associate? In order to apply, the prohibited act should also have a causal connection to the injury. In other words, even if the employee was engaging in a prohibited act, if it had no bearing on the injury (the injury would have occurred regardless), the doctrine might not apply.
When you have a workers’ compensation claim that could involve prohibited acts, it’s important to get all the facts. A claims adjuster will want copies of any policies, manuals or employment contracts specifying the prohibited act, along with documentation of the incident.