Workers’ insurance often gives people the peace of mind that their health and finances will be taken care of in the event they can no longer work. However, an insurance company may deny your workers compensation claim for many reasons. The denial of your workers’ insurance is not necessarily final. You have the right to appeal the denial of your workers’ insurance claim in some states.
Here are five common reasons for an insurance company’s denial of a workers’ compensation claim.
The injury did not occur at work
Insurance companies often deny workers insurance claims when the injury did not occur at work. Insurers typically give less leeway for what can be considered work-related injuries. This can be a problem because it is often difficult to determine whether a particular incident occurred in the course of one’s employment. Even if the employer and employee agree that the injury occurred at work, an insurance company may still deny the claim because it was determined to be not work-related.
The worker was intoxicated
Workers’ insurance claims are also denied if a worker was intoxicated at the time of their accident. An insurer does not want to pay for the drunk driving accident that the person is responsible for, for example. Consequently, an insurance company will deny a workers’ compensation claim in these situations.
The injury was “idiopathic”
Insurance companies also deny workers insurance claims if the injury is idiopathic. Idiopathic means that the cause of the injury is unknown. In other words, an insurance company denies insurance claims if there was no obvious cause for the injury.
The worker was engaged in “horseplay”
Insurance companies can deny insurance claims if the worker was engaged in horseplay. Horseplay is a legal term that refers to light and casual activities that are not serious. For example, a person may be denied a workers’ insurance claim if they were injured when they fell off their chair while attempting to spin around, or if they were hit by another person playing with a toy gun.
The worker is not an “employee”
Workers’ insurance claims are usually denied if the worker is not an “employee” of the employer. For example, two different people could both be injured at work on the same day. Both would receive workers’ insurance benefits. However, only one would be considered an employee of the company. Insurance companies will usually consider a worker to be an employee if they are paid by the employer to perform a given task.