After becoming injured or sick at work, a worker claims for worker’s compensation benefits. However, in many cases, their claims are denied by the insurance company. Since many workers are not well aware of the law, Charles Spinelli offers an insight into some common incidences that generally result in denial of the claim.
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The Injury Didn’t Take Place at Work
Employees become eligible for medical and other benefits of workers’ comp only if the injury occurs while performing their job duties. For instance, if a construction worker experiences a sprain and tear of the ligaments due to the hazardous work site, the worker is most likely to get insurance benefits. Conversely, if it happens during the lunch break or while commuting to work, the worker will be denied the benefit.
However, if that worker is asked to meet the building material supplier and experiences an accident on the way, he/she is supposed to have a claim. Contextually, workers need to know that the primary job of insurance companies, or sometimes even the employers to find the gaps to prove that the injury doesn’t happen on the job. In such cases, working with a worker’s compensation lawyer is highly recommended to avail the compensation.
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The Worker Was Intoxicated When the Accident Happened
If the worker is found intoxicated or under the influence of drugs or alcohol at the time of the accident, worker’s compensation insurance is not entitled to compensate the claim. Apart from the above reason, according to the worker’s compensation insurance rule, workers do not get coverage of insurance in the events of:
- The worker’s injury is caused by issues related to mental health which is not a consequence of his/her work.
- A worker gets injured while fighting with any co-worker; due to negligence to wear safety gear or it was a self-inflicted injury.
- The worker experienced injury when he/she was away from the workplace and not involved in any work-related job
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The Worker Did Not Inform the Employer about The Injury Before The Stipulated Timeline
When it comes to the worker’s compensation-related claims, the worker on the job needs to notify the employer about the incident within a certain time limit. According to Charles Spinelli, this is why, after the injury, it is vital for a worker to report the injury to the employer right away or as soon as possible. This is because, after such an incident, the employer is also liable to carry out an investigation of the accident and accordingly, that report should be attached to the claim while furnishing it to the insurance carrier.
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The Worker Has a Pre-Existing Condition and the Injury or Ailment Is a Result of the Condition
If a worker had exposure to any injury or illness earlier before joining the workplace and the job is not the underlying cause that worsened it, typically the injured person will not be eligible as per workers’ compensation law.
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The Worker Was Not Treated By an Insurance Company-Approved Medical Provider
As per the workers’ comp system, employers and insurance companies possess the legal right to provide workers with a list of approved doctors to receive the necessary treatment.
However, it is not uncommon or might be a negative issue since the doctors under the network often have an understating with the insurer and/or employer to downplay the severity of the injury. Consequently, doing so makes the workers receive lower benefits.
According to Charles Spinelli, even though an injured or sick worker must contact an approved medical practitioner to be eligible for compensation benefits if the worker suspects that the doctor has downplayed, the victim should consult with a workers’ comp attorney immediately. This ensures not only the worker gets the best possible treatment but also higher benefits as entitled to.
Bottom-line:
In every case, the chance of defrauding an injured or sick worker at work by the insurer or employer is fairly common. They can play different tricks to rob the rights of the victims by proving they are not entitled to avail the benefits. Under such circumstances, it makes sense to consult a worker’s compensation lawyer to get a legitimate claim.
