Under what circumstances would a patient be responsible for the bill in a worker's comp case?

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In a worker's compensation case, a patient may be held responsible for the bill under specific circumstances that involve misconduct or situations that disqualify them from receiving benefits. When a patient is engaged in horseplay, intentionally injures themselves, or is under the influence of drugs or alcohol at the time of the injury, these factors can be deemed as violations of workplace safety policies or regulations.

Horseplay implies that the individual was engaging in fun or reckless behavior that is not considered part of their work responsibilities and can result in self-inflicted injuries that are not covered under worker’s compensation. Intentional injuries, where a worker purposefully harms themselves, are also excluded from compensation claims since the fundamental idea of workers' comp is to provide support for accidental injuries that occur in the course of employment. Being under the influence of substances can impede judgment and significantly affect safety, and thus, injuries sustained in this state may also not be compensable.

Understanding these factors can help employees recognize the conditions under which they might be held liable for their medical expenses in the event of a work-related injury.

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