Not all injuries that happen at work are covered by workers’ comp. However, just because the workers comp insurance carrier denied your claim doesn’t mean you shouldn’t keep fighting. They have an incentive to deny claims….they don’t want to pay. So, if there is anything they can do to refuse to accept your claim, they often will.
Fortunately, you can fight back successfully. Don’t give up. A typical denied claim may involve a situation where the injured worker says something like this:
“I was bending down to pick something up & I felt pain in my back.”
The comp carrier will almost always deny this claim. Why? ***Because you have to describe your injury as ‘arising out of your employment.’*** To put it in non-lawyer speak, this means that something about your job was at least partly to blame for your injury. Just bending down is a typical thing that could happen anywhere. Hurting your back while bending down after strenuous lifting or other activity related to your job could be covered by comp. Bending down while holding something related to your work (tools, files, etc.) could be covered by comp. It just depends on how you explain what happened. If you are talking to a representative of the workers’ comp insurance company before you have a lawyer, be careful….Choose your words carefully if you are explaining how you got hurt. Again, with the help of an experienced workers’ comp lawyer, you have a better chance in making sure your rights are protected.
They often deny claims because they will say the injury was the result of “cumulative trauma.” Don’t get discouraged. Regardless of what the insurance carrier says, you have the right to challenge their denial. Some so-called “cumulative trauma” injuries can be covered by workers’ comp. It depends on the specific facts of your situation.
So remember, you usually need to show two main things in order to make sure you can fight back if the workers’ comp insurance carrier denies your claim. One, your injury occurred in the course of your employment. Two, your injury arose out of that same employment.
The statements contained herein are for general information purposes only. This is NOT to be considered specific legal advice to your situation as Mr. Shoen would need to meet with you individually to ensure the client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult directly with an attorney for legal advice.