In Missouri, if you are an employee and you get hurt on the job, you can be entitled to workers’ compensation. However, workers’ compensation is a type of insurance: Your employer pays regular premiums to an insurance company so the company pays for certain costs of workplace injuries that fall within the policy’s coverage.
Importantly, some workplace accidents and injuries are going to fall outside the realm of that policy’s coverage. In these cases, your claim for workers’ compensation is going to get denied.
Here are eight reasons why your employer can justifiably deny your workers’ compensation claim. If your claim gets denied for one of these reasons, you can appeal. If your injury happened in western Missouri, the personal injury and workers’ compensation lawyers at the Smith Law Office can help. Call them at (816) 875-9373 or contact them online.
1. Intentionally Self-Inflicted Injuries
Workers’ compensation covers the costs of workplace accidents. Injuries caused by intentionally hurting yourself on the job are not covered. This is an extremely rare event, though some people who get hurt off the job may then try to make it seem like a workplace injury by intentionally injuring the same body part at work.
Employers who are looking for a reason to deny your claim may turn to this rationale, in spite of its rarity.
2. Intentional Conduct By Other Workers
Similarly, injuries caused by intentional conduct by other co-workers, like in an assault, are not covered by workers’ compensation. These are not workplace accidents.
However, you can file a third party claim against the co-worker, instead. Unfortunately, in Missouri, co-workers can rarely be held liable for their conduct.
3. Failure to Seek Medical Treatment
To recover workers’ compensation, you are going to have to show that you were, in fact, hurt. This generally requires a doctor’s note. In many cases, you will have to get a medical examination from a doctor of your employer’s choosing. Failing or refusing to do this can get your claim denied.
4. Willful Negligence
Because workers’ compensation is limited to workplace accidents, it also does not cover injuries caused by your willful negligence. This includes injuries that happen when, for example, you are under the influence of drugs or alcohol while on the job, or if you disregard workplace safety rules and get hurt.
5. The Injury Did Not Happen on the Job
Again, workers’ compensation only covers workplace accidents. If you were hurt off the job, the injury will fall outside the scope of workers’ comp.
However, there are numerous situations where it is ambiguous whether you were working or not when you got hurt. It can be wise to appeal a denial based on this rationale in many cases.
6. The Claim Was Filed After the Statute of Limitations Passed
Under Missouri Statute 287.430, workers’ compensation claims have to be filed within two years of the date of your injury. If you file your claim after those two years have passed, your employer can deny it.
This justification for a denial is especially common for claims related to occupational diseases.
7. You Did Not Notify Your Employer of the Injury
One of the first things that you have to do after getting hurt in the workplace is to notify your employer within a certain period of time. If you fail to do this, your claim can get denied.
8. You Are Not Covered By Workers’ Compensation
Workers’ compensation only covers employees, not anyone who works for your boss or employer. If you are an independent contractor, for example, and you get hurt on the worksite, any claim for workers’ compensation that you file against your client will likely get denied.