Reasons Your Workers’ Compensation Claim May Be Denied

BY: Koszdin | Wednesday, April 13, 2022.

California’s workers’ compensation laws are fairly strict and tend to favor employees. In some states, an employer might be exempt from purchasing workers’ compensation insurance depending on such factors as the number of employees they have.

That’s not the case in California. In our state, every employer needs to purchase workers’ compensation insurance. This is true even if they have only one employee.

If you are injured in a work-related accident, you technically have the right to seek compensation for your medical bills and other such losses by filing a claim to recover workers’ compensation benefits. However, the fact that you filed a claim does not mean you will immediately recover the compensation you may deserve.

Your employer might attempt to deny your workers’ compensation claim because they don’t want their insurance premiums to increase. An insurance company might attempt to deny your claim because they don’t want to pay you the money you may genuinely deserve.

There are various justifications an employer or insurer may cite when explaining why your claim was denied. They include the following:

Your Accident Was Not Genuinely Work-Related

To be eligible for workers’ compensation insurance, you must have been injured in an accident that occurred when you were acting as an employee in some capacity. For example, if you were driving to a worksite and you were involved in a car accident, it would be fairly clear that your accident occurred on-the-job. However, if you were driving during your lunch break when the accident happened, an employer or insurance company could easily argue that you were not operating as an employee at the time of your accident, and are thus not eligible to recover workers’ compensation benefits.

That is a fairly clear-cut example. That said, there are often gray areas when determining if an accident truly qualifies as being work-related. The fact that an employer or insurer states you were not on-the-job when your accident happened doesn’t mean they are truly representing the situation accurately.

You Were Intoxicated When Your Accident Occurred

An employee essentially waives their right to recover workers’ compensation insurance if they are intoxicated on-the-job. If they are injured in an accident that likely would not have occurred if they had been sober, they should not be able to recover workers’ comp.

Still, an entity denying a workers’ compensation claim on these grounds should be able to provide hard evidence showing that a claimant was intoxicated at the time of their accident. If they can’t do so, they may not be fairly representing the nature of the circumstances.

You Were Engaging in Horseplay

“Horseplay” is a vague term that is often used when employers and insurers try to justify denying workers’ compensation claims. They may suggest that injured employees were harmed because they were behaving recklessly. Again, this does not mean their version of events is grounded in reality.

Has your workers’ compensation claim been denied? Do you believe it was denied unfairly? If so, our team of Van Nuys workers’ compensation attorneys at Koszdin, Fields & Sherry is available to fight for your rights. Contact us online or call us at 800-747-3447 for more information.

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