Common Reasons Why Your Workers’ Compensation Claim May Be Denied
If you are hurt on the job, your employer is required to provide you with workers’ compensation coverage. This coverage should compensate you for lost wages, medical bills and other expenses related to your job injury. However, workers’ compensation benefits are normally paid by an insurance company and it is common knowledge that insurance companies look for reasons to avoid paying claims. Therefore, you may have received notice that your workers’ compensation claim was denied. There are several reasons why this may happen and a denial does not necessarily mean you will be unable to collect on your claim.
Course and Scope of Employment
In order for your employer to be required to pay workers’ compensation, your injury must have been caused within what is known as “the course and scope” of your employment. After an accident, the insurance company may determine that the injury occurred outside of your job duties or that the accident was not the result of performing the duties you were assigned.
Horseplay
If you were injured because you were playing around on the job, the insurance company may try to deny your claim. However, in Pennsylvania, unless the horseplay was significantly disconnected from your job duties, you are still eligible for compensation. For example, if you are a bartender who is tossing bottles back and forth with another bartender while serving drinks, you may be eligible for compensation if one of the bottles breaks causing a severe cut on your hand.
Willful Misconduct
If an insurance company believes that there was willful misconduct, such as standing on a forklift while it is moving, your workers’ compensation claim may be denied. However, you may argue that the behavior that caused the injury does not rise to the level of willful misconduct.
Self-Inflicted Injuries
If your injury was self-inflicted, you do not qualify for workers’ compensation benefits under Pennsylvania law. It is the employer’s responsibility, however, to prove that your injury was self-inflicted. There have been cases where video evidence showed an employee purposely dropping a heavy object on a foot or hand in an effort to collect workers’ compensation benefits.
Under the Influence of Drugs or Alcohol
If your employer can demonstrate that you were under the influence of drugs or alcohol and that the injury would not have occurred had you not been under the influence, you cannot collect workers’ compensation benefits. If the injury would have occurred even without the influence of drugs or alcohol, it is possible you may still be eligible for benefits, however.
Occupational Diseases and Idiopathic Conditions
In some cases, you may be able to file a workers’ compensation claim if you suffer from a condition that can be linked to your employment, such as seizures or a heart attack. The insurance company may deny your workers’ compensation benefits claiming that the condition was not caused by your job duties. You may also qualify for workers’ compensation if you are diagnosed with a disease that can be related to your job, such as lung cancer. The insurance company may claim that there is no causal relationship between your work duties and the illness. It is your responsibility to provide medical evidence that your job duties led you to contract the disease.
If you or a loved one has filed a workers’ compensation claim that has been denied, contact the workers’ compensation attorneys at Lundy Law today to learn what rights you may have. You may arrange for an initial consultation by calling 1-800-Lundy Law or completing the simple form on our website.
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