Virtually all injuries that occur while you’re on the job or on your employer’s property are covered through workers’ compensation. However, there are some situations under which claims may be denied. Workers that experience a claim denial due to these situations may want to consult with a work injury attorney to determine whether they should appeal the decision.
Here are five of the more common reasons why a company may dispute a claim.
1. If the Injury is Deemed to be Self-Inflicted
Self-inflicted injury is a broader area than it may at first seem to be. As an example, starting a fight with your coworker is classed as a self-inflicted injury. Thus, if you did get into a fight with a coworker, you might need to prove that it was not you who started the fight to qualify for compensation.
2. If the Injury Violated the Company’s Policies
Many companies have written policies that need to be followed, especially as concerns safety. An employee not wearing safety glasses despite written instructions to do so in their employee manual may not qualify for compensation if they are injured. This can be a complex situation because there may be times when verbal orders do not agree with written ones. A supervisor, for example, might specifically as an employee to do something that is against company safety standards. This is where having thorough documentation is extremely important.
3. If the Injury Occurred through Criminal Action
Obviously, employees who are breaking the law when they are injured are usually not covered as though they were simply injured on the job. This type of injury could occur if an employee was breaking into a property to steal an item from it.
4. If the Injury Occurred While Not on the Job
Though this may seem straightforward, there are situations in which an employee could be on company property but not on the job or on the job but not on company property. As an example, an employee could be injured on the employer’s property due to safety hazards on the site but either before or after they actually clocked in. An employee could also be injured while driving to or from a client site. These situations will usually need to be looked at on a case by case basis.
5. If the Injury Occurred While the Employee Was Intoxicated
An employee who is intoxicated at the time of injury will usually be denied coverage and the company will usually not have liability. However, there are some gray areas. An employee who is impaired due to prescription medication may still qualify for compensation if their employer was made aware of the medication and if they were not doing anything they were not supposed to be doing under its effects. This is another example of a situation which can be somewhat contentious.
These situations can be complex and they may be abused by an employer who doesn’t want to be liable for an employee’s injury. Speaking with an attorney is the only way to determine whether or not your personal injury should qualify for compensation, either via workers’ compensation or your employer.