As an insurance claims professional or risk manager for a large employer, you know that not every incident that occurs on your property is a compensable workers’ compensation claim. Two of the most effective defenses involve injuries stemming from voluntary recreational activities and employee horseplay. Successfully litigating these exceptions requires a precise understanding of the law and a diligent investigation.
The voluntary recreational activity defense
New York Workers’ Compensation Law Section 10 provides a specific exclusion for injuries arising from voluntary recreational activities. The key word is “voluntary.” This defense applies when you can demonstrate that the activity was not sponsored, required or paid for by the employer.
An employee playing in an unauthorized pickup basketball game during an unpaid lunch break and suffering a sprained ankle is a classic example. The defense hinges on proving the activity was purely for the employee’s own leisure. Compensation is not payable simply because the injury occurred on company grounds. To build a strong case, focus on establishing:
- The absence of any employer sponsorship or financial support for the activity
- That participation was not expected or required as a condition of employment
- The activity occurred outside of paid work time
The horseplay defense
Horseplay presents a different challenge. This defense applies when an employee engages in reckless, impulsive behavior that deviates from their work duties. The critical question is whether the employee abandoned their work for personal amusement.
Imagine a warehouse worker who intentionally jumps out to startle a colleague, slips and falls. Their actions were a substantial deviation from their job duties. However, this defense can be nuanced. If horseplay is a regular, tolerated part of the work culture, the NYS Workers’ Compensation Board may find it is not a complete deviation from employment, weakening your position.
Building an unbeatable defense
Merely alleging horseplay or a voluntary activity is not enough. You must build an undeniable record. Your defense strategy should be immediate and thorough.
Begin with a detailed investigation. Interview all witnesses promptly to secure statements about the exact nature of the event. Gather any available security footage that can visually support the claim that the employee was engaged in non-work-related behavior. This evidence is crucial for overcoming a claimant’s potential misrepresentation of the event.
Presenting a compelling case to the NYS Workers’ Compensation Board Judge means pairing this factual evidence with clear legal arguments. You must articulate how the employee’s actions fit squarely within the legal exceptions to compensability.
Protecting your bottom line
Understanding and proactively investigating these defenses is a powerful tool for controlling costs. A well-documented case can lead to a disputed claim being disallowed, protecting your company and your insurer from unnecessary payout. Always ensure your initial investigation aggressively pursues the facts needed to support these exceptions. A strong defense not only wins cases but also deters future questionable claims.