You have options if workers’ compensation won’t cover it

On Behalf of | Mar 4, 2022 | Workers' Compensation

Perhaps you’ve been clocking in and out of the same North Carolina job for years. You enjoy your work and, for the most part, get along well with your coworkers and employers. A successful career and pleasant working environment can take a sudden turn for the worst if you suffer a workplace injury, especially if workers’ compensation won’t cover it or an insurance agency denies your claim.

The two main issues to keep in mind if you have suffered an injury at work and are planning to file a workers’ compensation claim are the importance of providing specific and detailed information regarding your injuries and also providing evidence to show that your injury occurred in direct conjunction with your scope of employment.

Types of injuries that workers’ comp may not cover

In certain circumstances, someone may tell you that you are ineligible for workers’ compensation benefits based on the information you have provided in a claim. The following list includes issues that increase the chances of that happening:

  • You suffered injury in a collision in your own vehicle on the way to work.
  • You were fighting with a coworker or another person.
  • You were engaged in horseplay when the injury occurred.
  • The activity you were involved in when you suffered injury is against company policies.
  • You acted under the influence of drugs or alcohol.
  • You were committing a crime when the injury occurred.

These are some of the most common issues that would hinder eligibility for collecting workers’ comp benefits after a workplace injury has occurred.

Employer obligations and third-party claims

Your employer is obligated to provide you with proper training and any equipment that is available to help you stay safe on the job. You also have a right to work in a safe environment. If your injuries occurred by assault or because your employer did not fulfill his or her obligation to maintain safety, you may have grounds for filing a third-party liability claim in a civil court.

Appealing a denied workers’ comp claim

There are numerous reasons an insurance agency might deny a workers’ compensation claim. If your claim receives a denial, it doesn’t necessarily mean you won’t be collecting benefits. Many claims face denial in their initial processing but later receive approval upon appeal. For instance, perhaps you didn’t complete all the necessary paperwork the first time around or there was a clerical error on your application.

A denial might occur if you fail to show that your injury took place at work within the scope of your duties. If you wrote that you bent over and injured your back, an insurance agency might claim that such an injury could happen anywhere at any time. If, however, you wrote that you were loading boxes onto a shelf as part of your duties and suddenly felt pain in your lower back, it explains that your injury took place on the job within the scope of your employment.

Knowing how the system works can help you achieve your goals

The workers’ compensation program is in place to issue benefits that can help cover medical expenses, replace lost wages and provide additional financial support if you have suffered a workplace injury. It’s helpful to speak to someone who is well-versed in North Carolina employment law before navigating the system so that you are aware of your rights and options, especially if your initial claim receives a denial.