When an Employee May Be Denied Worker’s Compensation?

When an Employee May Be Denied Worker’s Compensation?

Workers Compensation law states that when a person or employee gets injured on the job, he or she receives compensation for those injuries without filing a lawsuit against the employer. If a worker suffers due to performing his job, he or she can file a claim and the employer investigates before agreeing to compensate for the injuries.
However, this compensation may not be applicable in all the cases- if the employer believes that the injuries are not the result of that job, he can deny compensating and can raise a defense against him.
Following are those conditions when an employer can deny the compensation rights of the worker(s):
If the Worker is Not Covered by Insurance:
It is not necessary that every employee is covered in worker’s compensation. Few executives, domestic employees, independent contractors, individuals or agricultural workers may not be covered under certain policies giving an employer the defense to deny the compensation. However, this does mean the employer cannot be held responsible for the injuries. The grounds provided by the worker may be insufficient to claim workers compensation.
If the Worker is failed to Provide Notice:
In order to get compensated, a worker must provide a notice to the employer that he or she developed an illness due to work or suffered a work-related injury. There is a deadline within which the employee has to provide notice to the employer. It can vary from 30 days, 60 days or even 90 days after the injury or knowing about illness- this time period differs from state to state. Having failed to provide notice, the employer may deny the claim to compensate the worker.
The Statue of Limitations has elapsed:
The employer can also deny the claim if the worker has not claimed the compensation within a certain period of time which is called, ‘Statue of Limitations.’ Once this time has elapsed, the employee(s) cannot claim the compensation.
The Injury was Not Caused by the Work:
Workers’ compensation provides compensation for the losses, illness or injuries only related to the work or caused by the work. If the employer doubts that the injuries were not caused due to the work, he or she may investigate the cause and deny the claim if the doubt becomes the truth. The actual cause of the injury must be found out by the employer such as an injury can occur at work but may not be caused by the job he or she is performing. Such as heart attack. An employer can also carry out an independent medical examination.
If the Injury is Cause due to Intentional Actions:
The workers’ compensation covers the accidental causes of the injuries and not the intentional acts. For example, if a coworker is not following safety instructions, the claim may bring forth, and if the injuries were the result of the assault by the coworker the claim not be covered the compensation.
Similarly, self-inflicted injuries, are not covered in the compensation. For example, a worker has deliberately inflicts injuries to his or herself, the employer can deny the compensation.
If the Injuries are the Result of Willful Negligence:
Willful negligence is by no means covered in the workers’ compensation. If an employee knowingly ignores or violates the safety rules, the employer use this action as a defense against the compensation claim.
If the Worker Does Not Seek Medical Treatment:
It is mandatory to seek medical treatment in order to get compensated under workers’ compensation insurance. Moreover, the employer can also require the injured employee to seek an independent medical examination from the doctor of his choice provided the state law gives this permission.
If the Injury is Not Compensable:
Based on the state laws, certain injuries are not compensable. These injuries or sufferings include stress-related suffering because they are difficult to prove and compensated.
The Injuries are Not Severe:
The injuries have to be severe enough to obstruct the performance of the worker. If the injuries claimed are not severe, and the worker can resume the work sooner, the claim stands void and can also result in a reduction of the benefits.
Seeking Legal Help?
If the injured worker wishes to file an appeal against the denial of the compensation, he or she can seek legal help by hiring the services of a workers’ compensation attorney. The attorney helps the worker in filing the appeal and giving him or her viable options to get the claim compensated.
Regardless of the state, you are living in, you have to prove that your injuries were the result of the job and were severe enough to be compensated. If your workers’ compensation claim is also denied and you feel dejected, you can hire a skilled attorney to make an appeal or find out how your claims are compensable.

California Workers Compensation Lawyers , APC - Long Beach

295 Redondo Ave, Suite 201

Long Beach, CA 90803


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