Workers’ compensation insurance coverage provides paid medical treatment and other benefits to employees who sustain job-related injuries or illnesses. However, employers sometimes dispute valid workplace injury claims. An employer and their workers’ compensation insurance carrier might argue that you had a pre-existing condition and weren’t hurt at work, or that your injuries are less severe than you claim. Why do employers fight workers’ comp claims, and how should you deal with workers’ compensation disputes?
Reasons Employers Fight Workers’ Compensation Claims
Can an employer fight a workers’ comp claim? Yes, employers often fight workers’ compensation claims for various reasons, primarily to save money.
Protect the Company’s Reputation
Some companies are afraid that a high number of workers’ compensation claims will damage their reputation and create a public perception that the company is poorly managed and has unsafe working conditions. High injury rates might discourage workers from seeking employment with the company and negatively affect the company’s bottom line.
Discourage Other Employees from Filing
Employers may contest claims because they believe that successful claims will encourage other injured workers to follow suit, thereby increasing the company’s medical costs. If an injured employee feels that it is challenging to receive workers’ compensation benefits, they might think the workers’ comp process is too frustrating. By discouraging workers from filing workers’ comp cases, employers can reduce the total number of claims.
Keep Insurance Premiums Down
Under North Carolina law, most employers are required to maintain workers’ compensation coverage. The premium costs depend partly on the amount the insurance provider pays in claims. As such, limiting the number of claims could ultimately save the employer money on insurance costs.
Protect Productivity and Workflow
Employers may also fight workers’ compensation claims to preserve productivity and workflow. If a key employee sustains an injury, it can drastically disrupt operations. Employers may incur additional costs from hiring and training temporary or replacement workers to fill missing roles. Fighting workers’ comp claims is a way to avoid costly business interruptions. An injured worker may feel pressure to return to work to preserve their income rather than stay home to heal.
Avoid Legal Implications
Another common reason employers fight workers’ comp claims is to avoid legal liability. If an employee sustains an injury and it’s discovered that the company violated safety regulations, the company could face workplace safety penalties and sanctions.
Common Tactics Used by Employers Fighting Workers’ Comp Claims
Some common tactics employers use to dispute and deny workers’ compensation claims include the following:
- Independent contractor: Workers’ compensation insurance covers employees, but not independent contractors. Some employers intentionally misclassify employees as independent contractors to avoid paying benefits and other expenses. Just because your employer claims you are an independent contractor doesn’t mean you are. A knowledgeable workers’ compensation attorney can review the terms of your employment and determine whether you should be categorized as an employee and entitled to workers’ comp benefits.
- Injury didn’t happen at work: Your employer might claim your injury didn’t happen at work and therefore isn’t covered by workers’ compensation. This is especially true for cumulative injuries that didn’t arise from a single incident. You may still qualify for benefits if you sustained a cumulative injury as a result of your work duties. Even if an injury occurred while you were away from your primary worksite, you can still be covered if you were off-site for work purposes, like attending a conference or training.
- You were responsible: Workers’ compensation will not cover your injuries if you were intoxicated on the job or if you willfully violated safety rules (C.G.S. § 97-12). Your employer might try to claim you were engaging in misconduct when you were hurt. This is why it’s essential to have a clear account of the accident, backed up by medical documentation and eyewitness testimony.
What to Do If an Employer Refuses to File a Workers’ Comp Claim
In North Carolina, you typically have 30 days to report your injury to your employer (N.C.G.S. § 97-22). Once you notify your employer, the employer must submit a claim to their insurance company. If your employer refuses to file your workers’ comp claim, you can file your claim directly with the North Carolina Industrial Commission. Keep records of all communications with your employer, including your attempts to report the injury. You can refer to these communications if your employer tries to claim you failed to report the injury or reported it late.
You should also contact a workers’ compensation attorney to discuss the matter. Aside from providing general legal guidance, a knowledgeable attorney can help you gather medical documentation and bills to prove the extent of your injuries and medical losses. An attorney can represent you in a hearing before the Industrial Commission and ensure you meet all relevant filing deadlines and requirements.
Employers who refuse to pay work injury benefits when obligated can be subject to fines and penalties.
How Our Raleigh Workers’ Compensation Lawyers Can Help
The last thing you need when recovering from a work injury is to fight your employer’s insurance company. The attorneys at Younce, Vtipil, Baznik & Banks, P.A., have over 90 years of combined legal experience pursuing workers’ compensation claims in Raleigh. We have successfully overseen hundreds of workers’ compensation cases, including several multi-million-dollar settlements for work-related injuries (although each case is unique and past results cannot guarantee future outcomes). We want to help you, too. Here is what one satisfied client had to say about our legal representation:
“Excellent communication and was very effective in analyzing the situation and working diligently to resolve the issues. I was very pleased with the professionalism and expertise of the staff and highly recommend them.” – Theodocia Shabazz
When our attorneys represent you, you can focus on the important things — your health, family, and well-being. Contact our offices online or call (919) 661-9000 today to schedule a complimentary case consultation with a workers’ compensation attorney in Raleigh, NC. Se habla Español.
About the Author
Joseph R. Baznik
Joseph Baznik is an attorney at Younce, Vtipil, Baznik & Banks P.A. who specializes in workers' compensation and personal injury. Joseph speaks both English and Spanish fluently. He is licensed to practice law in the State of North Carolina and the U.S. District Court for the Western District of North Carolina.
