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5 Reasons Employees Get Denied for Workers’ Compensation


Millions of Americans across the nation spend their days working in risky environments. Many workers push their physical limits every day, lifting, pushing, pulling, crouching, and crawling. Some are exposed to dangerous fumes, sharp objects, extreme heights, and harsh elements. Even in seemingly safe environments, employees can still be at risk of getting hurt. Even worse is that employees can put themselves at risk of not receiving appropriate compensation for their work-related injuries or illnesses.

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Most employers are required to obtain workers’ compensation insurance. When an employee gets injured on the job by accident or becomes ill because of the job, this insurance is meant to pay for medical expenses and time missed from work to recover. However, workers’ compensation can be a little bit tricky, and sometimes employees who actually deserve compensation are denied coverage.

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Here are five common reasons for getting denied:

1. Waiting too long to report the injury to their employer. Injuries and illnesses must be reported to an authority in writing right away. Otherwise, it is harder to prove that the injury occurred while working, and not from another activity outside of work.

2. Going to your own doctor. Some sick or injured employees go to their own doctors with whom they feel most comfortable. However, your preferred doctor may not be a medical provider within the employer’s insurance network. In order to get your medical bills covered by workers’ compensation, make sure you see a provider recommended by your employer that is within its insurance network.

3. An injury that is unrelated to the job. Some employees will get denied coverage because the injury was caused by an unrelated occurrence. In other words, injuries may happen at work, but are not related to the job itself. For example, if a family member brings your dog to your work to say hello, and your dog bites your ankle, you will not be covered even though it happened at work. On the other hand, if two employees get into a fistfight over the copy machine, and you get punched while innocently waiting to use the copy machine, you will likely be covered.

4. Failure to communicate. Another mistake some employees make is that they do not tell the doctor the whole story. Many workers are anxious to get back to work, and fail to detail the circumstances of the injury or list all aches and pains caused by the injury. However, if an employee requires more treatment for another body part affected by the injury, but did not clue the doctor in the first time, the workers’ compensation insurance may not cover it.

5. Pre-existing conditions. Workers’ compensation is wary of paying to treat an ailment that existed before the job. If a pre-existing condition is exacerbated by the work, compensation will likely be minimal if at all.

Keep in mind that not all employers are required to have workers’ compensation insurance. If you are injured or become ill while working on the job, discuss the possibility of workers’ compensation coverage with your employer.

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Do you know someone who has been injured while working, or who has become ill from his or her job? We want to hear from you! Leave a comment or join the discussion on Twitter.

Daniel Kalish
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Ivy Baker
Ivy Baker

This is some really good information about workers compensation cases and why they would get denied. Not communicating does seem like a huge reason why people would get their compensation denied. It does seem like it would be a good idea to over communicate with your company once you get hurt.


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