Workers’ compensation provides a process in which a person who is injured on the job can receive restitution for such injuries without having to sue their employer. However, not all claims are approved. There are a variety of reason you can be denied workers’ comp.
Each state has a deadline by which the employee must provide notice after suffering an injury on the job. Some states require up to 90 days after being injured and others as little as a few days. If the employee does not file a report within a specific period of time, the employer may be able to deny the claim. Some exceptions may be made such as if the employee suffers from an occupational disease. Also, you can be denied workers’ comp if you file a claim after you’ve been fired or have quit your job.
Not Work Related
An injury or illness may have occurred during work but not viable for a claim. Examples are a heart attack, stroke or other debilitating circumstance.
Intentional Acts or Negligence
Workers’ compensation is mostly for accidents only. If an employee willingly violates safety rules, causes a self-inflicted injury to file a false claim or gets them or others injured during horseplay they would be denied workers’ comp.
Under The Influence
If you are under the influence of alcohol or illegal narcotics during your accident or injury you will be denied workers’ comp.
Not Seeking Medical Care
In order to properly document and process workers’ comp the claimant must usually seek medical treatment. If the claimant treats themselves the lack of a medical report can seriously cause their claim to be revoked.
Discrepancy of Reports
It’s the insurer’s objective to obtain all documentation related to the employee’s injury. This would include the employee’s accident report filed with their employer and the medical report created from seeking treatment. If the medical report does not show the injuries that occurred on the accident report the employer could refute the claim.
Workers’ compensation does not necessarily cover every worker. Independent contractors, specific executives, agricultural workers or individuals covered under different policies may also be exempted from coverage. While this may not mean that the employer is not legally responsible for injuries, it may be adequate grounds to deny the workers’ compensation claim.