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Reasons you might deny a workers' comp claim

When you started your business in Lafayette, you made it a point to do everything in your power to provide a safe work environment for your employees. In addition, you have always offered competitive wages and benefits. You know that if you take care of your employees, they will take care of your company. However, this does not mean that everyone that works for you has the best intentions.

In the past, when a worker has been injured on the job, you have not hesitated in approving his or her workers' compensation claim. You feel it is your duty to look out for your employees. But what do you do if you think a workers' compensation claim might be fraudulent? Is there a way to defend against a workers' compensation claim? Fortunately, you do have some options available. Read below for common defenses against worker's compensation claims.

Notice not given

Louisiana state law requires that employees notify their employers of work-related injuries within a certain time frame. Typically, an employee can give verbal or written notice and it can be delivered by a spouse, doctor, or someone else. If an employee fails to provide notice within the state's required time frame, an employer has the right to deny the claim.

Filing limitations

In addition to a time limit for providing notice, employees have time limits when it comes to actually filing the claim. In many cases, the statute of limitations begins when the employee suffers the injury or becomes aware of an injury or illness. If a worker does not file the claim within the statute of limitations, your workers' compensation insurer can refuse to provide benefits.

Self-harm

Workers' compensation insurance exists to provide benefits to employees that suffer an accident while on the job. This means that if a staff member intentionally hurts himself in order to collect benefits, you can deny the claim on the basis of fraud.

Injury is not work-related

In order for a workers' compensation claim to be valid, the injury or illness must occur as a direct result of work-related activities. For example, if a worker suffers a minor cut at work but does not treat it properly with antiseptic and infection follows, worker's compensation will probably not cover any treatment that is a result of the lack of reasonable care.

Failure to go to appointments

When an employee files for workers' compensation benefits, he must see a doctor and get a physical examination in order to verify the claim. The insurer will also use the exam results to determine the amount of benefits the employee should receive and for how long. If your staff member does not show up for the required doctor appointments, then the insurer can deny the claim.

Intentional negligence, horseplay, and the inability to fully determine the cause of the injury are also valid reasons to defend against a workers' compensation claim. If you suspect one of your employees has filed a fraudulent workers' compensation claim, you may need to take legal action.

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