December 13, 2022 | Workers' compensation

Most employers are required by law to provide their employees with workers’ compensation coverage. Workers’ compensation insurance provides workers with a financial cushion when they suffer a serious injury at work. This insurance protects both the worker and the employer. Unfortunately, the employers and insurance companies are finding loopholes that allow them to abuse the workers’ compensation system at the expense of workers. Below we discuss some of these loopholes.

• The classification of the employee

Not every worker is covered by workers’ compensation. Independent contractors for example are often exempted from coverage. Employers can take advantage of this to list some workers as independent contractors. When the worker is injured, the employer can claim that they are not covered under their workers’ compensation insurance coverage. Many workers are surprised to learn that their employer classified them as an independent contractor and that they are not eligible for compensation.

• Employers taking ghost policies

Many employers are finding a way around workers’ compensation laws by taking out ‘ghost’ policies. These policies are either non-existent or are less than what is required to cover their workers. Employers may use this tactic in order to avoid paying workers’ compensation insurance .This leaves workers either completely unprotected or underinsured. As a result, injured workers find themselves with huge medical debts.

• A failed drug test

Employers or their insurance providers may insist that you take a drug test after the accident. Failing this drug test can result in your workers’ compensation claim being denied. Employers and their insurance providers may claim that you were intoxicated at work and this was the reason you were involved in an accident. They therefore have reason to deny your claim.

• The injury or illness is not work-related

Workers’ compensation coverage is designed to cover injuries and illnesses that are related to employment. However, many illnesses that are work related such as cancer can have other causes. Injuries may also occur off the job site while carrying out work related tasks. Employers and insurance companies may argue that the injury occurred while the worker was carrying out personal tasks.

• The statute of limitations

Employers and their insurance companies can use the statute of limitations as a reason to deny workers compensation. The statute of limitations is the time limit within which a worker is required to make their claim. If they fail to make their claim within this period, they may no longer be able to pursue compensation. Unfortunately, some workers are not aware of this time limit. They may wait until they are fully recovered to start the process of making a claim and this may be too late.

• Not seeking immediate medical treatment

In order for a worker to receive workers’ compensation benefits they must have received medical treatment. The medical report will be used to show the extent of the injuries as well as their cause. However, if an worker fails to seek immediate medical attention, they risk not being able to recover compensation. Their employer and the insurance provider may claim that the injuries they are making a claim for are not related to the work accident.

Employers and insurance providers may also require workers to receive an independent medical examination from a doctor of their choosing. If you fail to attend your appointment, this can be used as grounds to deny the workers’ compensation claim.

• The injury is not compensable

Depending on the law in your state, some injuries may not be compensable. For example, if you suffered a stress-related injury or illness, you may not be able to recover compensation for your injuries or illness even if it is work-related. Some injuries and illnesses are also difficult to prove as being work-related. You may therefore not be able to recover compensation.

• The existence of prior injuries

Sometimes workers suffer injuries as a result of the aggravation of a previous injury or may their health condition may become worse as a result of their tasks at work. Employers and insurance providers may argue that the illness or injury is not work-related as there was an existing injury or illness. They will use this argument to deny your claim.

• The actions of the worker or their co-workers

Workers’ compensation is designed to cover accidents. If the injury was the result of the negligent or reckless behavior of the worker or their co-workers, the employer and their insurance provider can get away with denying the workers’ compensation claim. This may be the case for self-inflicted injuries, if the worker was intoxicated, the worker violated safety rules, if the worker and their co-workers was engaged in horseplay and other similar situations.

Conclusion

There are various loopholes that employers and insurance providers can use to deny your workers’ compensation claim. It is therefore important to seek the guidance and representation of an experienced workers’ compensation attorney. Contact us now to schedule free consultation.