If you have been injured on the job, you should qualify for compensation under your employer's workers' compensation insurance. Unfortunately, your employer as well as their insurer have a vested monetary interest in not paying your claim. Although there are steps you can take if they choose to go this route, here are a few reasons that claims are denied the first time around. Avoid these and you have a better chance of being approved.
Your Employer States You Are Not an Employee
Employers are required by law to cover anyone who is their employee under their workers' compensation insurance. Unfortunately, some try to lower their premiums as well as avoid claims by stating that certain groups of people are not employees. Some businesses will even try to separate out these workers by showing their salaries on 1099s versus W-2 forms. Titles used for these groups often include independent contractors or consultants. But is this truly who these groups of workers are?
An employee, as defined by the IRS under common-law rules, is someone who performs services for another person who has the ability to control what and how the services will be done. Questions that are often asked when determining who qualifies as an employee are these:
- Are you told what, when, and how to do your tasks?
- Can you be disciplined if your work or job performance is not up to par?
- Do you earn an hourly, weekly, or monthly wage?
It can be a substantial hurdle if you wait to file your workers' compensation claim until after you are fired or laid off. The employer may attempt to argue that your injury did not occur during the time you were employed.
If you file a claim and it is denied due to you not being an employee, you will need to hire a workers' compensation attorney who will be able to argue your employment standing.
You Do Not File Your Claim within the Prescribed Time Frames
When it comes to a workers' compensation claim there are two important time frames that you must adhere to. These two are
- the number of days you have to report your injury to your employer
- the amount of time you have to actually file your claim
These numbers may be the same, or there may be a vast difference between the two. This is because the time limits for reporting your claim can vary from employer to employer and the limits for filing your claim vary from state to state. Some of these state windows for filing can be as small as 30 days, and others, such as those in California, can be as long as five years.
The most important thing you need to do is report the injury to your employer as soon as possible after it occurs. Prompt reporting can help to preserve your rights to file your workers' compensation claim in the future. Always make sure that you know your employer's requirements for reporting as well as for filing a claim.
You Have Drugs in Your System at the Time of Your Injury
Many employers have policies in place that require you to be drug tested any time you have a workplace injury. Depending on the type of accident you have, testing may include the use of a breathalyzer or a urine or blood test. Many times workers' compensation will deny your claim if any type of drugs are found, and you may face disciplinary actions by your employer.
You should never report to work under the influence of any type of illegal drugs. If you are on a prescription drug that could affect your job performance, you need to ensure that your employer is aware of it. Not only will these prescription drugs also show up in your drug screen, but this will keep your employer from claiming they did not know you could possibly be in an altered state.
If your workers' compensation claim is denied the first time you file it, do not give up. Call a workers' compensation attorney to discuss the best course of action at this point, but make sure you make the telephone call quickly. This is because the appeal rights you have in conjunction with your denial have very quick deadlines. If there is a legal firm near your workplace, check it out as well to get another opinion.