Who Decides Who Gets Workers’ Compensation?

Suppose you were recently diagnosed with a work-related illness, repetitive injury, or had an injury accident at work. In that case, you may feel as if your life has been turned upside down. You’re likely in pain and uncomfortable while trying to determine when and how you will return to work so you can continue to pay your bills. You may be trying to recover from your illness or injury while simultaneously wondering how you will pay your medical bills. The good news is that if your injury or illness is work-related, you likely have a valid workers’ compensation claim. Such a claim can pay your medical bills and pay a large portion of your lost wages while you cannot work.

Who Decides Workers’ Comp Claims?

Workers’ comp laws ensure that employees who are injured on the job obtain fixed monetary awards without filing a lawsuit for their claims against their employers. Because of this, workers’ comp is a crucial safety net for employees when they are hurt or become ill on the job or as a result of their job. Workers’ comp is a no-fault system meaning that neither the employer nor the employee can blame the other for their injury.

Each state has its own worker’s compensation laws. Employers and insurance companies offer workers’ comp insurance in accordance with these laws. The state lawmakers, your employer, and its insurance company decide whether or not certain employees are to receive workers’ compensation for their illness or injury. If you believe your claim has been unfairly or illegally denied, you have the right to file an appeal. An experienced workers’ compensation appeals attorney can help you with this step.

Are You Eligible for Workers’ Compensation?

In some circumstances, you may not qualify for workers’ compensation, such as:

  • Your injury or illness isn’t work-related
  • You were intoxicated at the time you sustained the injury
  • You intentionally harmed yourself or engaged in behavior that you knew could have a high likelihood of being dangerous, such as “walking” a tall ladder while you were at the top of it
  • You voluntarily engaged in physical violence with someone at work
  • You were involved in criminal activity at the time you suffered your injury
  • You were voluntarily participating in recreation related to your employment, or you were off duty when you were injured

Do You Need Help With Your Workers’ Compensation Claim?

Unfortunately, denying workers’ comp claims is common practice for some insurance companies and employers, leading to many wrongly denied claims. It’s best to have a well-versed workers’ comp claim attorney by your side during this long and sometimes arduous process. Employers and insurance companies must abide by state laws when it comes to approving or denying workers comp claims, but they aren’t always compliant. With an attorney on your side, you can ensure that you take all the proper steps from the beginning, decreasing your chances that your claim will be denied. If it is denied, your attorney can help you file a strong appeal.