Call Us (201) 664-2973 ☰ ˟
Get A Quote Customer Service


Johl & Company
(201) 664-2973
  • Home
  • Coverage
    • Automobile
    • Business
    • Commercial Auto
    • Cyber Liability
    • Health
    • Homeowners
    • Life
    • Motorcycle
    • Personal Umbrella
    • Workers Compensation
  • Get a Quote
    • Automobile
    • Business
    • Commercial Auto
    • Health
    • Homeowners
    • Life
    • Motorcycle
  • Blog
  • Resources
    • Refer a Friend
    • Important Links
    • Insurance Glossary
  • About Us
    • About Johl & Company
    • Our Office
    • Our Reviews
    • Privacy Policy
  • Contact
Auto Icon Home Icon Business Icon Life Icon Health Icon Boat Icon
Home > Blog > When Can a Workers Compensation Claim be Denied?
WEDNESDAY, NOVEMBER 25, 2020

When Can a Workers Compensation Claim be Denied?

Work injury claim form

Workers compensation insurance is designed to cover expenses related to a workplace injury, but not all injuries are covered. In some cases, an insurer may deny a workers compensation claim, meaning the employee will have to pay for medical bills related to their injuries.

Excluded Injuries

Sometimes, the nature of an injury can be what causes a workers compensation claim to be denied. Workers compensation only covers injuries that occur at work or in the course of work-related activities.

This generally excludes sudden unrelated illnesses and pre-existing conditions. There are some exceptions when it comes to pre-existing conditions, but they are few and generally rare. For example, say you have a disc in your back. Your job is not physical, allowing you to sit and stand as you need. There is no direct link to your job and your back even if it grows worse, so you would likely not be able to file a workers compensation claim. However, if you can prove that a pre-existing condition has grown worse due to a work-related injury, you may be able to file for workers compensation. You would need solid proof from a medical professional in order for a claim to be approved, however.

Excluded Accidents

In other cases, it is the accident that causes the injury which can lead to a workers compensation claim being denied. Qualifying workplace accidents must happen during the course of work or on work property. If an employee is injured at home after a shift, or at a neighboring business while off work, they will likely not be covered under workers compensation insurance. Other exclusions include:

  • Injuries that occur in a fight with another person that the injured employee started
  • Injuries that occur while the employee is under the influence of drugs or alcohol
  • Injuries that occur while the employee is participating in illegal activities

Other Exclusions

Workers compensation claims can be denied despite the injury or accident qualifying for a claim. Most workers compensation policies have guidelines the employer and employee must follow when filing a claim. If these guidelines are not followed, a claim could be ignored.

For example, many policies have a list of approved healthcare providers along with a time period in which an injured employee must see them. If the employee does not see an approved healthcare provider, or waits more than thirty days to receive medical treatment, a workers compensation claim could be denied.

Get A Quote

Posted 12:25 PM

Tags: business insurance, commercial insurance, workers compensation insurance, workers comp
Share |


No Comments


Post a Comment
Required
Required (Not Displayed)
Required


All comments are moderated and stripped of HTML.

NOTICE: This blog and website are made available by the publisher for educational and informational purposes only. It is not be used as a substitute for competent insurance, legal, or tax advice from a licensed professional in your state. By using this blog site you understand that there is no broker client relationship between you and the blog and website publisher.
Blog Archive
  • 2023
  • 2022
  • 2021
  • 2020

  • auto insurance(5)
  • life insurance(4)
  • workers compensation insurance(4)
  • business insurance(4)
  • health insurance(3)
  • commercial insurance(3)
  • liability(2)
  • insurance(2)
  • general liability insurance(2)
  • bop insurance(2)
  • commercial(2)
  • home insurance(2)
  • coverage(2)
  • commercial auto insurance(2)
  • general(1)
  • renters insurance(1)
  • flood insurance(1)
  • cyber(1)
  • bop(1)
  • remote workers(1)
  • business(1)
  • business owners policy(1)
  • telecommuters(1)
  • summertime health risks(1)
  • workers comp(1)
  • small(1)
  • homeowners insurance(1)
  • car insurance(1)

View Mobile Version
Facebook
Twitter
Google Maps
LinkedIn
YouTube
Get Directions
Contact Us Today
Have Questions?
Contact Us
Resources
Get A Quote
Refer A Friend
Contact Us
About Us
Our Carriers
Blog
Contact us 199 Center Ave.
Westwood, NJ 07675

(201) 664-2973
Fax: (201) 664-7015
© Copyright 2021. All rights reserved. Powered by Insurance Website Builder.