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When can an employer rightfully reject a workers’ comp claim?

Workers’ compensation is a system that was put into place to support employees who suffer work-related injuries or illnesses and to limit the liability of employers under related circumstances. However, workers’ comp is not an absolute right. There are situations in which an employer may legitimately reject a workers’ compensation claim. 

For example, an injury must be work-related. If an employee’s injury did not occur in the course of their job duties, an employer has grounds to reject their claim. Employers also rely on strict timelines; if an employee fails to report an injury within the designated period required by state law, an employer may have just cause to deny the claim.

Additional considerations

Not all types of injuries are covered by workers’ compensation. Common exceptions include those that result from an employee’s intoxication or use of illegal drugs, self-inflicted wounds or injuries sustained while committing a crime or violating company policies.

Also, discrepancies between an employee’s account of the incident and the findings of an investigation can result in claim rejection. If evidence suggests that the claim is fraudulent or exaggerated, employers not only can but should reject the claim to protect against abuse of the system.

Employers are entitled to reject workers’ compensation claims that are non-compliant with legal standards, but they should do so judiciously and fairly, both because that is the right thing to do, and also because making this effort can help businesses avoid concerns linked to discrimination, retaliation and/or other unfair business practices. Seeking legal guidance is always a good option should questions about this issue arise. 

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