---
title: NYS Appellate Court Finds WC Claim Compensable
description: NY Appellate Court rules Workers' Compensation claim compensable despite worker's intoxication, emphasizing the difficulty of overcoming insurance provisions. Learn more about this significant case.
image: https://blog.tsibinc.com/hubfs/AdobeStock_979023149.jpeg
---
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{id=5635333354, name=Claims, slug=claims}
# Knowledge Corner
December 20, 2024
## NYS Appellate Court Finds WC Claim Compensable
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An electrical worker was injured when he fell from a ladder at a job site in New York State. Although he was found to be intoxicated at the time, it was determined by the appellate court, that the claim [should be compensable](https://www.claimsjournal.com/news/national/2024/10/21/326928.htm) under the Workers’ Compensation law.
The law presumes that the injury is compensable for “disability or death from injury arising out of and in the course of employment without regard to fault as a cause of the injury, except when the injury has been solely occasioned by intoxication from alcohol.”
In [this specific case](https://www.claimsjournal.com/news/national/2024/10/21/326928.htm), the court found that the intoxication was a contributory factor and not the sole factor in the incident. The presumption is that it is not the sole factor and, further, that it was the responsibility of the insurance carrier to prove otherwise.
The employee was alone when he allegedly fell 8 feet off a ladder, and the toxicology report indicated the claimant was severely intoxicated by alcohol at the time of his fall. He claimed multiple injuries, including traumatic brain injury. The Workers’ Compensation carrier denied the claim as being solely caused by the intoxication. The [Workers’ Compensation Board](https://www.wcb.ny.gov/) (WCB) ruled against the carrier, and the carrier appealed.
The court agreed with the Board, finding that intoxication contributed to the accident, but there were other contributory factors, namely the absence of other employees assisting or holding the ladder, a misplaced foot, lack of a safety rail and the “inherent risk of working at height.” The WCB concluded that the carrier did not rebut the presumption of compensability, and the appeal did not overturn the WCB’s ruling.
[Workers’ Compensation insurance](https://tsibinc.com/insurance/commercial-insurance/workers-compensation-insurance/) was formed as a “trade off” of covering workplace injuries without regard for fault in lieu of the injured employee having to sue his employer for them or having to turn to public assistance. There is a general presupposition built into the system that when an injury occurs during a worker's employment, it is assumed to be compensable. Under New York Workers’ Compensation law, it is specifically set forth that, absent substantial evidence to the contrary, an accident will be compensable. This case highlights the difficulty in overcoming specific provisions in insurance law even when the claimant was intoxicated.
Although the principle of providing medical treatment and lost wage replacement underlying Workers’ Compensation is universal, each state has its own specific laws and procedures that dictate the acceptance and path of a claim. This case may not have had the same outcome in other states under their specific laws. [Contact TSIB](https://tsibinc.com/contact-us/)and speak with one of our team members for more information regarding your insurance coverage and claims services.
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Topics: [Claims](https://blog.tsibinc.com/topic/claims)
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