Workers compensation insurance is required in most states to provide employees with a source of compensation after a workplace injury. If your employee is injured on the job, they may need help with medical expenses and your business may need protection against a possible lawsuit.
However, workers compensation doesn’t cover every accident. A workers compensation claim could be denied due to:
Lack of Evidence
One of the most important parts of workers compensation is having a witness. If no one is around to witness the injury, you may have a difficult time convincing others that it occurred (depending on the extent of the injury.) Some workplaces have cameras, in part for this reason. If the accident occurred in an area with a camera, you may ask that the video be reviewed. Tell your co-workers and your supervisor right away with a detailed account of what happened. It can help to take pictures of the injury as well, if at all possible.
When you file a workers compensation claim, your employer’s insurance company will send a claims adjuster to investigate the incident. If the adjuster finds any inconsistencies within your claim, you could be denied compensation. Whenever recounting the accident that led to the injury, make sure to keep the story consistent. Be aware that your medical records will also be reviewed, so your story should be told the same to your manager, the adjuster and your medical provider.
Wrong Timing in Filing the Claim
Most workers compensation policies have a time limit on how long you can wait to file a claim. If you delay seeking help, the insurance agency may believe that you are not injured or that your injury is not severe enough for workers compensation benefit. You may be expected to file a claim within the week that it occurs.
After an accident occurs, it’s best to immediately inform a supervisor, fill out an accident report and seek medical attention.
Drugs or Alcohol Were Involved
In each case of workers compensation claims, the employee will be drug tested. If it is discovered that you were under the influence of drugs or alcohol at the time the accident occurred, the claim will likely be denied on the basis that the injury was due to intoxication. You may also be denied a claim if you are hurt roughhousing or starting a fight. Pre-existing conditions can also be denied.
Employees should notify their employer immediately of an injury and employers should ensure that the proper procedures are taken.
Also Read: Can an Employer Deny You a Workers Compensation Claim?
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