Workers’ compensation insurance coverage is one of the only universal benefits that every Florida employee should receive. Not every worker qualifies for protection under federal statutes allowing for unpaid medical leave or entitling them to accommodations for medical conditions, but even someone who just started a part-time job should have protection through workers’ compensation.
If someone gets hurt at work or develops a job-related medical condition, they can file a claim to receive healthcare and disability benefits. Unfortunately, sometimes the insurance companies involved will fight a worker’s claim.
What are the most common reasons for insurance companies to deny someone’s claim for workers’ compensation benefits?
- They put the blame on the worker
State law makes it clear that in certain situations where the employee is to blame, they will not be eligible for workers’ compensation benefits.
If there is video footage of someone intentionally hurting themselves or if a worker publicly talked about filing a claim for workers’ compensation before their injury, that might lead to the insurance company disputing their claim. Failed drug and alcohol testing can also lead to claims that a worker was to blame for their own injuries and therefore not eligible for benefits.
- They claim the injury happened elsewhere
If there were no witnesses when you got hurt and your employer doesn’t have security cameras, there may not be any proof that you actually fell down that flight of stairs. Insurance companies may sometimes try to place the blame on hurt individuals by asserting that they got hurt at home or on their own time, not while performing their job.
- They claim a worker violated company policy
When your employer has specific business rules, breaking those rules might affect your eligibility for workers’ compensation coverage. For example, if you have to wear a hard hat while performing certain tasks and did not, the insurance company could try to blame you for your injury.
- They blame a worker for being medically non-compliant
You typically have to follow the medical instructions provided by the physician overseeing your care if you want to continue receiving medical coverage and disability pay.
If the doctor indicates to the insurance company that you are non-compliant because you refuse to attend physical therapy sessions or won’t consider the surgery that they deem necessary to get you back on the job, the company can potentially deny you benefits because your refusal to follow medical orders directly contributes to your persistent or worsening symptoms.
Workers who understand the issues that can affect their eligibility for benefits will have an easier time avoiding mistakes that could prove financially devastating. Educating yourself about workers’ compensation benefits will make it easier for you to navigate the claim and get help if an insurance company is uncooperative.