Insurance companies, including workers’ compensation insurance companies, make money by accepting premiums, not by paying claims. The larger your workers’ compensation claim is, the more resistance you can expect. Several defenses may be available for the insurance company to contest your claim, depending on the circumstances. Following is a list of some of the most common defenses asserted against workers’ compensation claims.
The Statute of Limitations
Kentucky workers are required to file a workers’ compensation, if at all, within two years of the date of injury. This deadline can become ambiguous for claims such as repetitive motion injuries that take place over a long period of time. In general, though, once the statute of limitations deadline passes, the claim is dead.
Work Relationship
The insurance company might claim that you are an independent contractor, not an employee. Which designation applies depends on how much independence you enjoy from your employer, not how your employer classifies you. Ultimately, a court or administrative tribunal makes this decision. A plumber called in to fix a sink at a software company is a clear example of an independent contractor relationship.
Psychological Trauma
If you claim workers’ compensation for a psychological malady such as depression or PTSD, it must be directly connected to a physical injury to render you eligible for workers’ compensation benefits. This is not the rule in every state, but it is the rule in Kentucky.
Pre-Existing Condition
The insurance company may claim that your injury was pre-existing — that you already suffered from it before the accident that triggered your claim for workers’ compensation benefits. If you are claiming a back injury, for example, and you were involved in a serious auto accident several years ago, the insurance company might blame your back problems on the auto accident.
Off-Duty Injuries
The insurance company might also argue that your injury did not occur during while you were on duty or performing services for your employer. Off-duty injuries are not covered by the workers’ compensation system.
Intoxication
You cannot collect workers’ compensation benefits if your injury was caused by your own voluntary intoxication. Your intoxication must have been voluntary for this defense to work. If you became intoxicated by inhaling toxic fumes at work, for example, your intoxication would be considered involuntary. Your intoxication must also have actually caused the injury you suffered. If the accident would have happened anyway, intoxication is no defense against your claim.
Injuries Caused by Your Own Negligence or Intentional Act
Injuries caused by your intentional act (self-harm) cannot be compensated, and neither can injuries that occur because you intentionally attempted to injure someone else — by picking a fight, for example.
Even though workers’ compensation is generally a “no fault” system (no inquiry is made into whose fault the accident was), the no-fault system generally does not apply if the injury occurred because you were engaged in horseplay. In such cases, workers’ compensation will not pay.
Strike While the Iron is Hot
If at all possible, don’t wait until the insurance company asserts a defense to retain a lawyer. A skilled workers’ compensation lawyer can anticipate possible defenses even before they are asserted. And remember — you pay nothing up front, only after your claim is resolved in your favor. You pay nothing unless we win your claim, and if we win, our fees are limited by law to a certain percentage of your recovery.
Call Kentucky workers’ compensation lawyer Glenn Martin Hammond at (606) 437-7777, or complete our online contact form, for a free consultation where we can discuss your situation.