Can My Employer Deny My Workers’ Compensation Claim?

Employees who suffer from workplace injury can claim workers’ compensation without having to sue their employer. While most employees receive payment for most injuries, there are a few situations when your employer can deny your workers’ compensation.

About the Workers’ Compensation Process

You first have to understand the workers’ compensation process to understand a possible case denial.

You can file for a workers’ compensation claim if you get injured while performing some job-related tasks. Your employer won’t agree to it immediately.

You will have to get examined by a doctor your employer hires.

It’s to ascertain that the injury was indeed work-related. And it’s not always that you get compensated for your injuries.

Your employer may deny your claim for the following reasons:

a) Not providing notice

Injured workers must serve notice to their employer about their work-related injury or illness.

All states have a deadline for employees to give notice. It’s usually 30, 45, or 90 days after being injured or learning of the illness. Some even require notice within four days.

Failure to report the illness on time gives the employer enough reason to deny the claim. Some state laws are even specific about the type of notification to provide like a written statement.

b) No insurance coverage

It’s not always that all employees have workers’ compensation coverage. For example, independent contractors are generally exempted from coverage.

So are some executives, agricultural workers, domestic employees, and anyone covered under other policies.

The absence of insurance coverage doesn’t mean that the employer isn’t legally responsible for injuries. But it’s enough reason for them to deny your workers’ compensation claim.

c) Statute of limitations

Employers can also deny your workers’ compensation claim if a relevant statute of limitations has passed.

About the statute of limitations, it determines the time limit you have to make a claim.

Your employer will no longer pursue it once it lapses.

However, there are some exceptions to the general statute, like if you have an occupational disease.

d) Something intentional

Workers’ compensation is coverage only for accidents, and not for something done intentionally. So while it covers a co-worker’s negligent actions like not following safety instructions, it won’t cover something intentional like assault.

Similarly, there’s no compensation for any self-inflicted or intentional work injuries made just to file a fraudulent claim.

e) Wilful negligence

Your wilful negligence is another reason for your employer to deny your claim.

Examples of willful negligence are horseplay, and you’re getting intoxicated, or not following safety rules.

It’s more than enough for your employer to use against your favor and deny the claim.

f) Not work-related

Workers’ compensation applies only to work-related injuries or illnesses.

Your employer can deny your claim if they prove that the injury wasn’t work-related.

An independent medical examination determines the cause of injury before paying the claim. It’s because while some injuries may have occurred at work, it however is because of something else like a heart attack.

g) Nothing serious

You may have to return to work sooner if you suffer from an injury that is not so severe. You’re being able to return to your regular job duties will however lead to a reduction in your benefits.

h) Not getting treated

You can claim workers’ compensation only if you undergo medical treatment for the injury. you can’t make a claim for injuries you treat at home or with some rest.

And if the state law permits, you may also have to undergo a medical examination of your employer’s choosing.

Failure to get treated, or attend these medical appointments is enough grounds for your employer to deny your claim.

i) Incompensable injury

According to state laws, there are a few injuries that are not compensable.

Stress-related injuries are an example because they are difficult to treat and not compensable.

Time to File an Appeal

You will have to file an appeal if your workers’ compensation claim is denied. Your Glendale workers’ compensation attorney can help you with filing an appeal.