Workers’ compensation provides significant financial benefits to employees who are injured at work. Depending on the injury’s severity and cause, you may be eligible to have your medical expenses paid, and if you had to take time off work, you can be paid for a portion of what you would have made while working. Medical expenses can include surgeries, prescriptions, and visits to diagnose your injury. However, workers’ compensation doesn’t automatically pay out for every injury. There are specific cases where they’ll refuse to pay at all.
The Injury Didn’t Happen at Work
This seems like an obvious reason to deny a claim, but this can actually be a bit tricky. Obviously, if your injury occurs at home or while you’re on a weekend camping trip with your family, workers’ compensation wouldn’t cover it. But you might be injured while performing your job duties at an offsite location or while attending a company event, such as a retreat. Those are instances where workers’ compensation may deny your claim even though it may be valid, and you may be able to appeal.
The Injury Wasn’t Reported in Time
Workers’ compensation law varies from state to state. However, all states have a limit for how long you have to report the injury in writing to your employer as well as how long you have to file a claim for workers’ compensation. In most states, you have longer to file a claim than to report the injury to your employer. But, if you don’t report your injury within the required timeframe, worker’s compensation law says that you can lose your eligibility and have your claim denied.
The Injury Resulted From Horseplay, Practical Jokes, or Fighting
Workers’ compensation is exactly what it says: compensation for workers who are hurt while working. Therefore, if you weren’t working when you were injured, your claim can be denied. Horseplay, practical jokes, and fights are three examples of situations where you might have been injured at work but not working when you’re injured. And in those three examples, your claim would be denied because you weren’t working. Of course, this is another instance where things can be tricky. If you were not actively involved in horseplay, practical jokes, or a fight but are injured as a result of someone else doing those things, you may have options.
The Injury Happened While Under the Influence
Drugs and alcohol are not tolerated in the workplace. And if you’re injured while under the influence of either, your workers’ compensation claim may be denied. This is why, in most cases, you need to take a drug test when you get injured at work. It’s also why you need to report any prescription medications you may be taking, especially opiates, at the beginning of your claim. Refusal to take a drug test can also be grounds to deny your claim.
The Injury Wasn’t Treated by an Approved Medical Provider
Another reason your claim may be denied is if you were never treated for your injury or it was treated by an unapproved medical provider. Often, your employer will provide you with a specific list of approved providers you can see for your injury. Seeking treatment elsewhere, or not getting treated because you think it’s not that bad, can result in a denied claim later. While you don’t need to report and seek treatment for every papercut and minor scrape, it is important that you report and seek treatment from an approved provider for any injury you think might be more substantial. However, if you feel that the approved medical provider didn’t properly diagnose or treat you, you can look for a second opinion.
Workers’ compensation law can be very tricky. Employers and their workers’ compensation insurance don’t want to pay if they don’t have to. Which means they’ll look for the smallest reasons to legally deny your claim. It’s important to protect yourself and your rights by doing everything you can to ensure your claim is clear, clean, and undeniable.