The vast majority of business owners today are mindful of the health and wellbeing of their employees, especially when an employee is injured on the job. Unfortunately, some employers do not react kindly or appropriately when an employee suffers a work-related injury and files a workers compensation claim. Employer denial of the claim and employer retaliation are two serious problems that injured workers may face. Although it’s ultimately up to the workers compensation insurance provider to deny or accept a claim, an employer’s denial can directly affect the insurer’s decision.
Employer Denial of a Claim
There are several reasons why a business owner might deny a employee’s claim — and the insurer might agree with the denial. Common reasons for claim to be denied are:
- The injury did not happen at work or the injury/illness was not incurred during/due to a work-related task
- The injury occurred due to employee misconduct (e.g., drug use, intoxication, intentional violence)
- The employee is falsifying the claim or exaggerating the extent of the injury
- The employee didn’t need substantial medical care for the injury and does not need time off from work to recovery
If any of these are true, the employee’s claim will likely be denied. Employers tend to be more likely to deny claims when an employee cannot produce evidence of their injury/illness. For example, a broken bone will clearly show up on an x-ray, while carpal tunnel syndrome likely won’t show up on an x-ray and is usually only diagnosed through the patient’s testimony. It’s far more likely that an employer would refute a claim for carpal tunnel syndrome rather than a claim for a broken bone.
An employer might also deny a claim if it means that their premiums will increase. Workers compensation policies are insurance programs and employers can be charged higher premiums if they are labeled high-risk. A business owner who has several workers file claims each year will likely be charged a higher premium than a business owner who has only had one or two employees file claims.
However, if an employee can provide proof that they do have a valid claim — even after their employer has denied the claim — it may still be possible to receive coverage.
Some injured workers find that they become the targets of retaliatory measures before or after filing a workers compensation claim. There have been instances in the past of employers using threats, demotions, and other retaliatory measures as a way of discouraging or punishing workers for filing claims.
If you believe you’ve been the victim of this behavior, it’s essential to contact the best work injury lawyers Milwaukee, WI residents trust. Employers are not allowed to retaliate against employees who file for workers compensation after suffering a work-related injury or illness. Each state processes these cases differently, but one thing is the same in every state: it’s illegal. You may be able to file a lawsuit against an employer for unlawful retaliation in addition to pursuing benefits through the employer’s workers compensation policy. These types of situations can become very complicated very quickly, so it’s smart to contact a workers comp lawyer as soon as possible.
Thank you to our friends and contributors at Hickey & Turim for their insight into workers compensation claims.