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Why would an employer reject a workers’ compensation claim?

Ohio employees whose employers rejected their claims for insurance benefits may have questions about their eligibility. Workers’ compensation is insurance that covers workplace injuries, regardless of who was at fault. Rejections can follow if injured employees were determined to be under the influence of drugs or alcohol. Also, injuries that occurred during criminal activities or in violation of company policy, or those that were self-inflicted, may not be covered. Furthermore, the injury must have occurred when the employee was on duty.

Workers’ compensation benefits typically cover hospital and doctors’ fees along with other medical costs such as medication and physical therapy. It will also cover a portion of lost wages, and if the injury prevents the worker from returning to his or her regular job, the benefits may also cover vocational training to teach the victim new skills. The system will provide survivors’ or death benefits to surviving loved ones of employees who died in on-the-job accidents.

The insurance program does not provide coverage for pain and suffering and other emotional damages. However, if the injury was caused by the intentional or gross negligence of an employer, the victim might pursue additional financial recovery through the civil court system. In some states, certain workers are not covered by workers’ compensation. These may include business owners, independent contractors, casual workers, volunteers, maritime and railroad employees, farmers and their workers, and private home employees.

The most appropriate step for an injured Ohio worker whose claim was denied may be to consult with an experienced workers’ compensation attorney. A lawyer can explain the claims process and determine eligibility for insurance benefits. An attorney can then assist with the navigation of the claims process and work toward obtaining maximum benefits.

Source: FindLaw, “Workers’ Comp Benefits Explained“, Accessed on Jan. 12, 2018