As someone who works in the insurance business, you’ve likely seen your fair share of cases in which individuals have filed claims to benefits when they aren’t entitled to receive them. There are several instances in which you as an insurer may deny an individual’s claim for workers’ compensation benefits.
Many claimants must think that their good actors. This is the only thing that would explain why so many individuals try to request workers’ compensation benefits even though they aren’t sick or hurt. One of the most common reasons why insurers have to deny a person’s request for benefits is because none of the medical records show that there’s anything wrong with them.
Another common reason why insurers end up having to deny individuals’ workers’ compensation claims is because their illness or injury was determined to have been caused by their pre-existing condition, substance abuse or stress.
As you’re well aware, workers’ compensation coverage works differently from other types of insurance. An individual must fit the statutory definition of a covered employee according to New York state law to be eligible to file a workers’ compensation claim in the first place.
Any injuries or illness that that person alleges that they suffered must have occurred on the job for it to be a coverable condition. Their condition must have resulted from their employer’s negligence and not their own. If a worker fails to meet these basic guidelines, then you may be able to lawfully deny their claim.
Another common reason why you may ultimately deny a person’s workers’ compensation claim is if they fail to submit their request for benefits within the statutory time frame.
Making sense of New York workers’ compensation laws isn’t easy. If you deny benefits to an employee here in Troy who really should have received them, then you open yourself up to being sued. Litigation can be costly. This is why you should have an attorney working for you to protect your interests. You can keep your exposure to legal liability to a minimum by having a lawyer on hand.
