Workers who are injured on the job are entitled to compensation for these injuries through workers' compensation insurance. An injured employee typically files a claim after suffering a work-related injury, which the insurer investigates before paying out benefits. The two main categories of claims are occupational disease claims and accidental injury claims.
However, not all injuries occurring at work or in the course of employment are compensable. Employers and their insurers have a number of workers' compensation defenses that may apply to a given claim.
For example, imagine an independent contractor falls and severely sprains his ankle after slipping on a freshly mopped section of the floor, which is unmarked. While the company may be been found negligent for not marking the slippery floor, the worker is not actually an employee of the company. Therefore, he is not eligible for workers' compensation benefits.
Depending on your circumstances, your claim may be blocked by one or more of the following workers' compensation defenses.
Failure to Give Notice to Your Employer
State workers' compensation laws require injured workers to provide their employers with notice of their injuries by a certain deadline, typically ranging from 30 to 90 days. In Illinois, for instance, workers must notify their employers within 45 days of the incident. Notice should be given to a supervisor either verbally or in writing, and may be given by the employee's spouse, doctor, or other third parties.
Statute of Limitations
Each state has a time limit for filing a workers' compensation claim (which is separate from the deadline for providing notice of the injury). Time limits typically range from one to three years. These statutes of limitations are usually more flexible in cases of occupational disease, such as injuries caused by exposure to toxins over time. For example, you may be required to file the claim within a certain period after the last known exposure. Failure to file your claim within the statute of limitations will void your ability to recover for injuries.
Injuries caused by the claimant are not compensable. This may include, for example, injuries sustained by the claimant intentionally in order to file a fraudulent claim. Another example would be injuries from a fight that the claimant started.
No Causal Link to Employment
In order to claim a work-related injury, there must be some causal link to employment. A common workers' compensation defense is to claim that the employee's injury is not related to employment activities. For example, a factory worker gets a minor scrape on her finger at work but fails to properly care for the wound. The finger becomes infected and eventually has to be amputated. She probably would not be eligible for coverage.
Not Attending Doctor Appointments
Part of your claim involves an independent medical examination, which is used to verify your claim and determine the amount of benefits required. Failure to show up to your appointment may be grounds for denial of your claim (or reduction in the amount).
Injury Not as Bad as Claimed
If you claim an injury prevents you from performing your regular job duties, but evidence suggests otherwise, you may be required to return to work sooner and your benefits may be reduced.
Willful Negligence or Horseplay
If you violate your employer's safety rules or perform employment duties while intoxicated, for example, any resulting injuries will not be covered by workers' compensation. In many cases, the employer and employee may have differing accounts of which party was actually negligent. Employers may claim "horseplay" as a workers' compensation defense if the claimant's injuries are the result of goofing off or being careless.
Unable to Determine Cause of Injury
The cause of the injury must be determined in order to process a workers' compensation claim. Even injuries that occur at work, such a heart attack, can be caused by factors not related to employment. The cause of the injury is determined through an independent medical examination.
Get Legal Advice Before Filing Your Claim
Determining whether you have a valid workers' compensation isn't always easy and may require the assistance of an experienced attorney. If you've been injured on the job, have a workers' compensation attorney evaluate your claim. They can help spot any possible workers' compensation defenses your employer may use to invalidate your claim.
Contact a qualified workers' compensation attorney to make sure your rights are protected.