Workers’
compensation is set up by employers as a way of keeping their
employees financially solvent after an injury. Compensation will
typically kick in for most injured individuals regardless of either
employer or employee negligence in the wound.
Unfortunately,
some employers may try to deny these claims and leave an employee in
a tough financial situation. Therefore, anybody injured at work due
to their own negligence must understand the complexities of this
process and how they can appeal any compensation denials.
Workers’
Comp Covers Some Employee Negligence
Workers’
compensation covers most cases of injuries caused by employee
negligence. For example, if a worker neglects to take proper lifting
procedures while picking up heavy goods, their back injury will still
be covered by workers’ compensation.
Moreover,
persistent problems, like lower-back pain caused by poor sitting
posture at a desk, will also be covered by workers’ compensation.
Employee negligence is rarely a factor in these cases because the
injuries still occurred at work and were a direct result of the
injured person's work duties. However, some types of employee
negligence will immediately cause claim denial.
Employee-Negligence
Injuries Not Covered by Workers’ Comp
Any
injury suffered on purpose by an employee is not covered by workers’
compensation. For example, an employee who cuts their hand on purpose
during their job duties will not receive payment. Denial of such
claims occurs because the employee is attempting to take advantage of
the compensation system for their gain.
Furthermore,
any injuries suffered while a person violates company policy are not
covered. For example, individuals may neglect following strict
protocol during a difficult forklift procedure and end up suffering
severe injuries. Denial of these damages occurs because the
individual failed to follow company guidelines according to their
contract.
Just
as importantly, workers’ compensation denies any injuries
experienced while breaking the law. For example, individuals injured
due to drinking alcohol or smoking marijuana at work will not receive
payment.
Unfortunately,
employers may try to argue that their employees were engaged in any
of the actions mentioned above — even if they weren't — as a way
of denying coverage.
Employers
May Try to Deny Coverage
Workers’
compensation payment comes from an insurance policy purchased by the
business to help injured employees stay financially solvent while out
of work. Therefore, most businesses don't fight too hard against
workers’ compensation claims. However, some businesses may try to
deny compensation claims due to employee negligence.
The
reasons behind these denial claims will vary. For example, the
employer may just not like the individual and attempt to hurt them by
denying payment. Other employers may be concerned about increased
insurance rates from their compensation provider and may try to
negate it with denial.
Thankfully,
denied workers’ compensation claims appeals help employees who were
negligent but not criminal in their injury. And in most cases, a
person appealing a denied claim will still receive a portion of their
workers' compensation.
Appealing
the Decision May Help
Most
workers’ compensation claim appeals start in mediation with a
non-biased official. Mediation provides individuals with a mediator
who can argue for their rights and try to get some form of
compensation for their injury. New evidence is not allowed during
this mediation, though, so the plaintiff must use the details
provided during the initial denial
However,
if the case cannot be sorted out in mediation, a trial may be
necessary. In a compensation trial, the injured employee must show
that their negligence was not self-inflicted or criminal, which may
be challenging to do alone. So please contact the Law
Offices of David A. Helfand, P.A.,
right
away if you are in this type of case and need help getting your
deserved workers’ compensation.
