Denied Workers’ Compensation? What To Know

If you work for an employer, chances are you are covered by their workers' compensation insurance policy. Workers who get hurt on the job, or are affected by an occupational disorder, can be provided with a variety of benefits like medical treatment costs, disability wages, and, in some cases, lump-sum settlements from the insurer. However, not all claims are approved, and your claim could fall into the grey areas discussed below.

Non-Work Related – The line between work injuries and non-work injuries can be fine. You should be covered if the injury occurred while at work but also while off-site doing work-related things. For example, if the boss sends you to the office supply store and you are hurt while on an errand, you should be covered. Travel for business, work parties, picnics, off-site training sessions—all of those should be covered.

Disobeying Safety Rules – Whether an employee is covered by workers' comp if they are injured while disobeying the rules depends on the circumstances. The employer must inform employees of the rules, they should be readily available, and they should post rules and provide safety training to ensure that employees know and understand the rules. If they do, then the employee may not be able to gain workers' compensation benefits when they are hurt. The employee would have to prove that they had no knowledge of the rule they violated to get benefits.

Fighting at Work – In most cases, employees who get involved in physical altercations are not eligible for workers' compensation benefits.

Criminal Behavior – Likewise, criminal acts that result in injuries will cause a denial of benefits.

Drug and Alcohol Use – This issue has become increasingly more common with the legalization of marijuana around the country.  However, just as you can be arrested for driving under the influence of a legal drug, you can also have your workers' comp benefits denied if your blood test finds any substance after an accident (except for prescription drugs).

What Happens Next?

When you are denied your benefits because of one of the above issues or something else, it would be a mistake to accept that as the final answer. All states allow hurt workers to file for an appeal after an adversary ruling is handed down by the workers' compensation insurer. Here is what you need to do:

  1. Make careful notes about your accident and everything that occurs afterward.
  2. Seek medical care even if you are not sure you are covered under workers' compensation. Inform the medical professionals that your injury was work-related.
  3. See to it that a claim form is filed even if your employer tries to discourage you.
  4. Speak to a workers' compensation lawyer about your case as soon as you receive a denial or when your employer refuses to cooperate with you.

Speak to a workers' compensation lawyer to find out more.