Defenses an Employer or Insurer May Use to Deny Workers' Compensation

Workers' Compensation Paperwork on the Computer ScreenWorkers who are injured on the job have a right to file for compensation for medical bills and lost wages through their employer’s workers' compensation insurance. However, it is important to recognize that not all injuries that occur at work are covered by workers' compensation—and employers and insurers may fight to deny benefits based on a few common defenses.

Defenses Against an Employee’s Claim for Workers' Compensation Benefits

Employers and their insurers have several legal defenses available to them in workers' compensation cases. While some of these defenses could be successfully argued against and overturned in an appeal, it may take the help of an attorney to gather the best evidence to prove your claim is valid.

An employer or insurer may deny workers' compensation benefits because:

  • There is not enough evidence to link the injury to your employment. In order for an injury to be considered work-related, there must be a definite causal link between the injury and the worker’s employment. The injury may be linked to the workplace if it happened on company property, in the course of the employee’s regular workday, or during a task that the worker was performing for the benefit of the employer. Some injuries, including occupational diseases or repetitive strain injuries, may be more difficult to claim because they worsen over time rather than in a single incident.  
  • You are not an employee. Only employees are covered under workers’ compensation laws. If you are providing a freelance service (such as babysitting or housekeeping) or are a consultant for a company, you are considered an independent contractor rather than an employee and are likely ineligible for benefits. However, it is worth mentioning that some companies misclassify employees as independent contractors rather than employees in order to deny them worker protections (such as injury benefits and minimum wage). In contrast, an independent contractor is not bound by the exclusive remedy provision of workers’ compensation, and is free to file an injury lawsuit if he or she is injured on the job. In these cases, it is best to consult with a work injury attorney to determine the best potential source of compensation.
  • You did not notify your employer of the injury. Each state requires an employee to notify an employer of an injury within a certain number of days in order to be eligible for workers' compensation. In Illinois, workers must notify an employer or supervisor within 45 days of the date an injury occurred. In Missouri, employees have just 30 days to report an injury or illness. This notice can be given by the employee or by the employee’s spouse, doctor, coworker, or other party, either verbally or in writing.
  • The statute of limitations has passed. Every state sets its own statute of limitations for filing a workers' compensation claim, which is separate from the deadline for notifying an employer. In Illinois, employees must file a claim with the Illinois Workers' Compensation Commission within two years from the date of last wage payment from a job, or three years from the date of injury, whichever is later.
  • Your injury was self-inflicted. Although workers' compensation is a no-fault benefit system, there are some limitations on when an employee’s actions may make him or her ineligible for benefits. If you intentionally caused the injury in order to file for workers’ compensation, this would be considered a fraudulent claim and benefits would likely be denied. Similarly, if you started a fight at work and were injured as a result, your employer would not be compelled to compensate you. Finally, the degree of your own negligence may play a part in whether your benefit claim is valid. If you were injured because you knowingly violated mandatory safety measures that could have prevented an injury, were performing employment duties while intoxicated, or were engaging in horseplay, employers may use these actions as a workers' compensation defense.

You Have Rights After a Workers' Compensation Claim Denial

If your workers' compensation claim has been denied, the first thing you should do is consult with a qualified workers' compensation attorney. Our legal team can investigate the incident and advise you on your next steps at no cost to you. Contact Tapella & Eberspacher today at (855) 522-5291 or fill out our online contact form to schedule your free consultation.