What Should I Do if I’m Denied Workers’ Compensation Coverage?

If you have suffered a work-related injury or illness, you should be able to obtain benefits through your employer’s workers’ compensation policy. Most companies in Virginia are required to carry this type of insurance, and this is generally the first place a worker should go to receive compensation. Workers’ comp. provides coverage for medical bills, a percentage of lost wages, rehabilitation/training, and compensation for a permanent disability.

If you apply for workers’ compensation benefits, your employer or their insurer could deny your claim. There are some valid reasons a claim may be denied, but unfortunately, there are many instances when there is no legitimate reason for denial. Organizations generally want to save as much money as they can on workers’ comp costs, and to accomplish this, they often deny an employee the coverage they deserve in an attempt to frustrate them into giving up.

What Are Some Common Reasons Employers Deny Workers’ Compensation Claims?

There are several reasons that employers and their insurers frequently deny workers’ comp claims, these include:

  1. The Injury Was Not Reported in Time

In general, you are supposed to report your injury to your employer within 30 days, and failure to do so can cause your claim to be denied. There are exceptions to this rule, however. For example, if your employer knew (or should have known) about your workplace accident within the 30-day window, then you may still have a valid claim. If the timing of your claim is an issue, speak with your lawyer about your specific situation to determine if you have a legitimate basis to appeal your denial.

  • The Injury Did Not Occur at Work

As mentioned previously, workers’ compensation is only available for work-related injuries or occupational illnesses. This means that the injury or illness must have happened while you were performing your job duties. For example, if you fell and broke your arm while you were on the clock and working, it would be pretty clear that you are eligible for benefits. If, on the other hand, you fell and broke your arm while you were at a restaurant on lunch break, your employer will probably deny the claim.

There is a gray area here, however. If you are off-site but still performing company duties, then you may still be eligible for benefits. Using the restaurant example again, if your boss sent you there to pick up lunch for you and the rest of your co-workers, then the injury may be considered work-related.

As an aside, whether or not you are eligible for workers’ compensation coverage for an injury that happens off-site, there is a chance you may be able to recover compensation for your losses through a personal injury claim against a third party. If a party other than your employer (such as the restaurant in the case of slipping and breaking your arm on lunch break) contributes to your injury, then they should be held liable. Speak with your lawyer about potential third-party lawsuit options.

  • You were Intoxicated when You were Injured

If your accident legitimately happened at work but it happened while you were under the influence of alcohol or drugs, then your claim will most likely be denied. An employer has the right to deny a claim when an employee gets injured while violating company policies such as drinking on the job, and when you go for medical treatment after the injury, your employer has the right to have you tested for alcohol or drugs.

  • The Injury was Self-Inflicted or it Happened because of Roughhousing or Horseplay

In addition to alcohol and drug use, employers and insurers can legitimately deny claims for injuries that happen because of other forms of employee misconduct or company policy violations. Examples include intentionally hurting yourself, roughhousing, horseplay, getting into a fight with a co-worker, or refusing to use required safety gear or equipment.

  • You Did not Seek Medical Treatment for Your Injury

You may not believe you need to see a doctor for every little bump, scrape, bruise, or cut that happens on the job, but if you want to apply for workers’ compensation benefits, you will need medical documentation to substantiate your claim. Without this documentation, the insurance company will most likely claim that you are faking your injury in order to obtain benefits. Whenever you suffer a moderate to severe injury after a workplace accident, get medical treatment as soon as possible, so you will be able to show your employer that you are legitimately injured.

  • You Did Not Hire a Workers’ Compensation Lawyer

You most certainly do not need a lawyer to file a workers’ comp claim, but you have a much better chance of successfully recovering benefits if you do. As unfair as it may seem, employers and insurance companies look at workers who do not have an attorney much differently than those who do. Without an attorney, they are much more likely to try to take advantage of the situation and find a way to deny your claim without a valid reason. With an attorney, you will be able to more smoothly navigate the complex claims process, putting you in the best possible position to obtain a favorable result.

Contact the Seasoned Attorneys at Schilling & Esposito

Whether you have just been injured on the job or you have been denied workers’ compensation benefits, Schilling and Esposito is here to help. We have extensive experience standing up for injured workers and helping them recover the compensation they deserve, and we are ready to go to work for you.

To schedule your free consultation with one of our attorneys, message us online or call our Richmond, VA office today at (804) 320-0950.


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