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What Disqualifies You From Workers' Comp?

Workers' compensation gives injured workers money to cover their medical costs, but depending on the circumstances surrounding your injury, your employer may deny your claim. Keep reading to find out why.

What Is Workers' Compensation?

If you are injured at work, your employer may grant workers' compensation to compensate for your losses. Generally, this is a part of most business insurance policies. Just like with regular insurance policies, a claim must fit within specific guidelines.

Both the employer and the insurance company have an obligation to act in good faith. This means that if an employee is injured at work because of safety issues, negligence, or other preventable causes, they must fulfill their duty to provide proper compensation.

However, some employers may deny workers' comp to avoid paying for your losses.

Why Your Claim May Be Denied

The insurer or employer may deny an injury claim if:

  • There were no witnesses
  • The injury wasn't reported immediately
  • There is a discrepancy between your account and the medical records
  • The medical exam found evidence of intoxication or drug use
  • You refused to provide a statement or sign medical documents related to the injury

It's important to note that evidence is crucial to a work injury claim. Insurers are less likely to provide coverage if there is not enough proof that the injury was an accident or due to negligence.

Insurers prefer witness accounts, but some jobs involve independent work or more isolated working conditions. For example, you may work at a remote construction site a few days a week. It's a small job, so you don't have a team with you, but there's an issue with one of the machines, and you're seriously injured. There wouldn't be any witnesses to the accident, but that doesn't mean your claim is invalid.

Additionally, insurers prefer to receive a claim as soon as possible after an accident. Whether it's a car accident or a work injury, you should call the company as quickly as possible. However, in some cases, that may not be possible if you were unconscious or comatose for a period after the accident.

Other issues with the claims may happen if there's a discrepancy between your account and the doctor's notes. For example, if you claim that your left leg was crushed in a turbine, but the doctor says it was your right, the insurer may deny coverage.

Negligence on your part or a lack of cooperation also factor into denial. However, if the insurance company or your employer asks you to sign questionable documents, you should immediately contact an attorney.

We Advocate For You

If you were denied a workers' compensation claim, Territorial Law can help. With over 60 years of experience, our legal team has the practical knowledge you need to pursue the compensation you deserve for your workplace injuries.

Denied workers' compensation? Contact Territorial Law today!