Workers Compensation: Your Safety Net

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Workers Compensation: Your Safety Net

You put your heart and soul into your job, so it seems only fair that you should be protected from harm while you’re there. Most good employers do go out of their way to provide safety training and equipment to keep their workers safe and protected from any hazards. Federal agencies, like the Occupational Safety and Health Administration, also have standards in place for employers to follow to keep their workers safe. However, sometimes accidents happen anyway, and when they do, workers compensation is meant to be your safety net. Most of the time, if you follow your company’s procedures for filing a workers compensation claim, you’ll be paid with no trouble. However, I know from experience that it isn’t always that easy. I started this blog to help you learn what to do when your company or their insurance company denies your workers compensation claim.

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The Two Ways That An Insurance Provider Will Try To Deny Your Claim

When you purchase insurance, you might assume that you will receive a payout from your insurance provider when you need it. However, there are two situations under which an insurance provider may choose to not compensate you for your expenses. 

The Scope of Coverage

One of the questions the insurance provider will ask is whether your claim fell within the scope of coverage. If your situation falls outside of the scope of coverage, it would be considered a "denial of coverage." However, if your situation falls within the scope of coverage but there is another factor that leads to your claim being denied, this would be considered a "disclaimer of coverage."

An example of a denial of coverage is when your home is damaged by a flood and your homeowner's insurance policy explicitly does not provide coverage for flood damage. If this is the case, the insurance provider will want to deny your claim. 

Accusations of Insurance Fraud

In some cases, your insurance provider might argue that you caused damage to your property intentionally and that your damages should not be reimbursed. When this is the case, you will need to turn to an insurance litigation attorney for help when proving that you did not commit insurance fraud. 

Insurance fraud can also bring about criminal penalties. If you believe that you might be investigated for insurance fraud, consult with a criminal defense attorney.

Breach of Policy

A disclaimer of coverage is when you would have been covered if not for a breach of contract. It is important to understand the difference between a disclaimer of coverage and a denial of coverage if you choose to fight the claim denial.

How To Take Legal Action

If your claim is denied and you were surprised, you should speak with an insurance litigation attorney. If there are any ambiguities in a policy, the court will typically rule in the favor of the policyholder. 

In some cases, your claim might simply be denied in bad faith. Typically, the insurance provider will use complicated jargon as a way to cover up the fact that the denial of your claim is illegitimate. 

They might not have adequately investigated your claim, they may not approve or deny a claim in a reasonable amount of time, they may fail to follow a law specific to your state. Regardless of the problem, an attorney will advise you on the best steps to take.

For more information, contact a law firm like Berg Plummer Johnson & Raval, LLP.