As an employee, you are likely aware of your rights to workers’ compensation if you were to suffer an injury related to your job. However, you may be surprised that there can be challenges faced when seeking these benefits. Even when you are entitled to compensation for a work injury, your employer or their insurance carrier may put up a fight.
Facing a denial or arguments against your claim for workers’ comp can be very overwhelming. Nonetheless, it is important to understand your options to overcome these challenges. Being aware of the defenses you may encounter could help you secure the benefits you are entitled to even when an attempt to block your claim is made.
Procedural defenses
With any claim for workers’ compensation, the claimant must file their claim within the parameters set for this claim process. A requirement set by state workers’ compensation law is to provide proper notice of their injury to their employer by the set deadline. This deadline is typically 30 to 90 days from the date of injury. Thus, a defense could be made against if a verbal or written notice was not made to their employer by this set deadline.
There is also a set time limit for filing a workers’ compensation claim. For most workplace injuries, this time limit ranges from one to three years from date of injury. If an employee fails to file their claim within the statute of limitations, this could be used as a defense to void the ability to recover compensation for the injury.
Defenses based on claim content
The contents of the claim, along with missing information, could be used as a defense against a workers’ comp claim. This could result in an insurance company finding that your injuries are not compensable due to being self-inflicted, not linked to their employment or a result of horseplay or the employee’s negligence.
An insurance company could block a claim because they are unable to determine the cause of injury based on the information provided in the claim. Failing to attend doctor appointments could be used as a defense, as this could be used to illustrate that they are not as hurt as they claim to be. Similarly, they may argue against benefits because the injury is not as bad as they claimed based on the medical records collected.
While it is not rare to deal with an insurance carrier fighting to block a claim or issue a denial, it can feel like a very personal and emotional matter. A workplace injury can cause an employee to suffer physically as well as financially due to the growing medical bills and lost wages, making workers’ compensation benefits essential to overcome these losses and damages. A legal professional can help you navigate the claim process and guide you through a denied claim.