Many workers’ compensation claims are simple and straightforward. There is an incident in the workplace. An employee sustains an obvious injury. They report the matter to their employer, seek medical care and file a workers’ compensation claim. They can then receive benefits, including medical coverage for their treatment and disability pay.
Employers typically work with employees who get hurt on the job as they pursue benefits. However, sometimes workers find themselves facing more contentious situations. Their employers may try to intervene in the claims process and prevent them from obtaining benefits.
What are some of the circumstances that might result in a company denying a workers’ compensation benefits request?
1. Concerns about injury origins
Workers’ compensation benefits are theoretically available for any job-related medical conditions. However, workers’ compensation does not apply to injuries sustained during the commute to work or while off the clock.
If an employer believes that a worker got hurt on their own time, that could result in a dispute about the underlying cause of their condition. An in-depth medical evaluation may be necessary to affirm that the worker’s employment was what caused their medical condition.
2. Tests indicating chemical impairment
It is common practice for employers to request drug and alcohol testing after a workplace incident. If a worker fails a drug and alcohol test, that could potentially open the door for a denied benefits claim. If the company can prove that intoxication was the cause of the worker’s injuries, the company can mentally deny the worker benefits.
3. False or exaggerated symptoms
Most working adults have a diligent work ethic. They want to do their jobs and receive fair wages for their efforts. However, some people try to abuse the system put in place for the protection of workers. They may claim that they got hurt when they actually have no significant symptoms.
They might also exaggerate the severity or extent of the symptoms they develop after a minor workplace incident. The goal may be to receive an excused absence from work with partial pay. When employers believe that workers have fabricated their conditions, lied about the extent of their injuries or even hurt themselves on purpose to qualify for benefits, that can affect an employee’s eligibility.
Those anticipating a complicated workers’ compensation benefits claim may need help asserting themselves. Reviewing the situation that led to the worker’s condition can help establish whether pursuing a workers’ compensation benefits claim or appeal might be the best option available.
