There are several instances when insurance providers refuse to pay for workers’ compensation claims and, that too, without any feasible reason. Many a times, they try to deceive injured people, so that they don’t have to accept their claims. Here are some ways listed below, which are used by these people to escape from paying workers’ compensation:-
- Non-compensable injuries– There are certain injuries, which are non-compensable, rendering to the norms and requirements of insurance companies. It is really imprecise and confusing so it’s best for people to know, which kinds of injuries are compensable and which are non-compensable.
- Unexplained injuries– If you don’t explain to your insurance provider that how your injury was caused due to and during your job then it will become easier for the insurer to declare your injury as unexplained and they are not responsible for the harm. So, make sure that you explain the cause and nature of your injury precisely.
- Pre-existing injuries– Insurance providers use this as an excuse and tell the victims that they have been suffering from prior injuries, a long way back. This gives them a chance to refuse payment against medical treatments. However, according to the laws of workers’ compensation, if any workplace injury aggravates a prior injury, a worker is fully entitled to workers’ compensation. So make sure that you use this knowledge properly and wisely.
- Absence of medical documentation– Insurers make this excuse when proper medical history, records, releases and information about a victim are not given to them. So, you should send all the necessary documents to your insurer as well as the state commission for workers’ compensation located in your region.
- Failure in reporting– Many insurers try to get away by stating that victims failed to report about their injuries on time. Nevertheless, injured workers are given a time period of 30 days to submit a report about their injuries. So, you should report within this time period but it’s best to report immediately to prevent all the hassle.
Mental injuries and stress faced by an employee are not compensable until and unless it’s proved that extremely and unusually strenuous employment situations were responsible for the condition. There must be certain extraordinary situations or physical injuries involved in the occurrence of mental injuries and subsequent mental conditions, if one wants to be compensated under the laws of workers’ compensation.
Injuries due to repetitive motion
The injury must be unexpected either gradual or distinct, so as to be identified as compensable for the workers’ compensation. Injuries caused due to repetitive motion like CTS can be considered as compensable, according to the laws.
Heart attacks occurring due to stressful occupational environment and overexertion are compensable in nature. However, there must be unexpected violence, exertion, or strain, which leads to heart troubles in victims. Only the unusual and unexpected conditions leading to heart attacks are eligible for workers’ compensation. On the contrary, if a heart attack and subsequent death occurs due to just an ordinary exertion, it will be non-compensable.
Other non-compensable injuries are intoxication, going to and fro work and Hernia. There are certain exceptions to them and if you want to know more, you should consult a proficient lawyer. You can easily find the best one at workinjurylawyerlosangeles.org. They all work towards the injured employee’s interest and help them get their much-deserved compensation.