Workplace Accidents Involving Alcohol: When Are Benefits Denied?

A workplace accident under the influence of alcohol does not automatically strip an employee of injury benefits, depending heavily on the specific degree of contribution to the incident.

Consequences of Alcohol Consumption at Work

Reporting to work after consuming alcohol or drinking on company premises can lead to severe consequences, including disciplinary termination. If an employee suffers a workplace accident in this state, it may strip them of the right to injury benefits, such as a one-off compensation payout.

However, the employer must investigate the circumstances of the accident and determine on that basis whether the benefits are genuinely unjustified. These rules stem from the Act of 30 October 2002 on social insurance for workplace accidents and occupational diseases.

Accident Definition and Equivalent Events

For an incident to be recognized as a workplace accident, it must be triggered by an external cause resulting in injury or death and must occur in connection with work. Certain events are treated equally to a workplace accident.

Entitled Benefits and Family Compensation

Following a workplace accident, individuals can receive injury-related benefits. The difference between standard sickness allowances and injury-related sickness or rehabilitation benefits lies in their higher amount, which equals 100 percent of the assessment base.

Family members of a victim who died from a workplace accident may be entitled to a one-off compensation payout. This compensation also applies in the event of a death resulting from a workplace accident involving a pensioner who was entitled to an accident insurance pension.

General Rules on Benefit Exclusion

Accident benefits are not granted to an insured person if the accident was caused solely by intentional or grossly negligent violations of life and health regulations, or if the individual contributed significantly to the accident while intoxicated or under the influence of drugs.

In such situations, the insured person will not receive an accident sickness insurance allowance, but will instead receive a standard, lower sickness allowance from the regular sickness insurance.

Gross Negligence and Supreme Court Rulings

If a workplace accident was caused exclusively by the employee’s intentional or grossly negligent violation of health and safety rules, accident benefits are withheld. However, benefits remain payable even if gross negligence was only one of the contributing causes.

The Supreme Court confirmed in a ruling that an injured party does not lose the right to accident benefits if, alongside their own proven rule violation, an objectively incorrect action by another participant also caused the traffic accident. If the worker’s behavior was merely a contributing factor and not the sole cause, they retain their rights.

Intoxication and Significant Contribution

Accident insurance benefits are withheld if an intoxicated or intoxicated-by-substances worker contributed significantly to causing the accident. The intoxication or substance impairment must be the primary cause for the benefits to be denied.

The Supreme Court and Appellate Courts emphasize that accident benefits are only denied if the intoxication substantially contributed to the accident, meaning the incident could have been avoided had the employee been sober.

Sobriety Testing Procedures

When there is a reasonable suspicion of intoxication or substance use, the employer must direct the employee to undergo testing to determine the concentration levels in their body. Employees are obligated to submit to this testing.

Refusal or behavior preventing the test leads to a loss of the right to benefits, unless the employee proves that valid reasons prevented them from undergoing the test.

ZUS Refusal and Appeal Processes

The employer must determine disqualifying circumstances during the post-accident procedure. If the employer fails to do so, the Social Insurance Institution (ZUS) may step in and issue a refusal via a formal decision.

Employees who disagree with decisions made by employers or ZUS can challenge them. If an employer pays only a standard allowance, the worker can ask ZUS to establish their right to an accident benefit. If ZUS issues a denial decision, an appeal must be filed in court, suspending benefit payouts until a final ruling is reached.