8 Scenarios When Insurer May Refuse Compensation to Injured Workmen

In today’s highly competitive business environment, employees’ rights have also gained more importance. In order to protect your organizations from the expensive lawsuits and large compensation payouts, it is advised to buy a workmen compensation insurance policy. In case any worker gets injured, the insurance company pays the compensation to the grieved party on behalf of the employer.

Also called Employers Liability Policy there are some scenarios when the workmen compensation insurer can refuse to pay compensation to the injured worker. Such like it is important to know what is included in the policy, it is equally necessary to understand what is not covered by the insurer. So, let’s start -

1. Delay in reporting the claim -  The insurer has all rights to reject the claim if the accident doesn’t get reported immediately. It is necessary to inform the insurer about work-related accidents or injuries within a short tenure.

2. Claim was filed after leaving the job -  Sometimes employees who were legitimately liable to receive compensation under the workmen compensation insurance policy delay filing the claim and by the time they file it, they get fired. In such a situation, the insurer considers it as a revenge claim against the company. This is another reason not to delay your claim filing otherwise you would have a difficult time in convincing your insurer that it was a legitimate work-related injury.

If you get injured at work and if you think there is the slightest chance of yours to miss the work, you should inform your supervisor and fill out the accident form.

3. Discrepancy in the accident report and medical report -  The insurer can deny workmen compensation insurance claim if the injured worker’s claim about how the accident happened was different than the medical reports.

4. Medical reports indicate the presence of drugs -  If the injury caused because the employee was under the influence of drugs or alcohol, the insurer rejects the claim without a second thought.

5.  Claim is filed for an injury which is not related to work -  A workmen compensation insurance company can refuse coverage if the injury was not related to work. For instance, you bring your dog to your workplace, but your dog bites you, in this case, you will not be given the coverage even though the accident occurred in the workplace.

6. Claim is for pre-existing medical conditions -  A workers’ compensation insurer is wary of paying for those injuries which were existed before the job.

7. Injury is caused due to willful disobedience of safety rules -  If the business has issued some safety norms for its employees, and one of its workers willfully disobey one of its rules and gets injured, the insurer has all rights to reject the claim. For instance, your company has made it mandatory to wear hand gloves while operating the machine.

However, you willfully disregard this rule and start operating the machine without the glove. Unfortunately, your one hand comes in the machine and gets injured. In this case, the insurer can refuse to give compensation due to a violation of safety norms.

8.  Employer compensates the injured worker - The role of the workmen compensation insurance is to cover the legal liability of the employer and pay compensation on its behalf to the injured worker. However, the insurer can refuse to settle the claim for that injury for which the employee has already received the compensation from its employer.

When an employee agrees to receive the compensation under a workmen compensation insurance policy, he/she has to leave the rights to sue the employer. The worker can’t get compensation for the same injury from both the employer and the insurance company.

Then there are other claims arising due to war perils, occupational ailments, etc.; which are not covered unless declared separately in the policy document.

In any case, the purpose of the workmen compensation insurance is to give financial protection to the company against costly legal claims which may arise due to workers’ injury. However, it doesn’t mean that the insurer will settle all the claims. Remember, only legitimate claims will be honored.  


on 25 July 2017
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