4 reasons why a workers’ comp claim would be denied

On Behalf of | Jul 12, 2024 | Workers' Compensation

Workers’ compensation is a program that helps pay for an employee’s medical bills, lost wages and other financial costs after a workplace accident. These benefits could help a worker recover from their injuries and support their family.

A workers’ comp claim could be denied. Here are a few common causes of workers’ comp denials: 

1. An injury happened outside of work

For an injured worker to apply for workers’ comp benefits, they must have been injured while working. For example, if something fell on an employee while they were working their shift. If an injury occurred outside of work, then a claim could be denied. One possible exception, however, is if an employee was driving while working when they were hit by another vehicle. 

2. An injury was self-inflicted

Workers’ comp is a no-fault system. What this means is that it does not matter if an employee made a mistake that led to their injuries or if a co-worker or employer caused an accident. However, a claim could be denied if an employee knowingly inflicted their wound with the intent of applying for benefits.

3. An injury happened because of a fight or substance use

In some cases, an employee may be denied workers’ comp benefits if they were injured during a fight they instigated. There may be an exception if an employee was defending themselves from an aggressive co-worker. Similarly, if an employee is injured because they were drunk or using a substance, a claim could be denied. 

4. An injury is not applicable 

An injury that disables an employee and prevents them from doing gainful work could be eligible for workers’ comp benefits. Some injuries do not qualify employees for workers’ comp benefits. For example, a cut or bruise from a minor fall may not prevent an employee from working, thus preventing them from gaining benefits.

If you were injured while working, legal guidance could help you apply for workers’ compensation benefits. 

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