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Self-insured? Know when to deny workers’ compensation claims

Being self-insured for workers’ compensation is a decision that some business owners make. If you’re one of these, you must remember that you’re solely responsible for handling workers’ compensation claims that get filed. One of these duties involves making sure that your company isn’t paying out fraudulent claims.

There are several instances in which you might not be liable for covering the injuries of a worker. For example, if the injury didn’t occur while the worker was on the clock, you likely aren’t responsible for it. A situation that falls under this category would be if an employee is at home and suffers a fall but then starts complaining of pain at work. Because the injury happened at home, the company has no liability.

Another reason why you might deny a claim is that the worker suffered a self-inflicted injury. Employees can’t willfully injure themselves just to file a claim. If the worker starts a fight and suffers an injury, your company likely isn’t liable. Even intoxication could prevent a worker from being able to receive workers’ compensation.

When you’re reviewing the injuries and information to determine how to handle a case, think carefully about the underlying cause of the incident. This might help you decide whether it meets the criteria for coverage. Just because something happens while an employee is working doesn’t mean that it is your responsibility. For example, a worker who has a heart attack may not be eligible for workers’ compensation because a heart condition might have caused it.

If you deny a workers’ compensation claim, be prepared to defend your decision. Having an attorney who can protect your company’s interests is beneficial in these situations.