Workers' Compensation Facts: Contested Cases

Workers' compensation insurance programs exist in every state in the United States. They're a way of protecting employees who are injured or become seriously ill due to events that take place while they are performing their jobs. The process is intended to make it easier for both employers and workers to deal with accidents and injuries that occur on the job but many cases are contested, which inevitably leads to a more complicated procedure. This article examines this important legal and financial issue.


The purpose of workers' compensation is to simplify the process of making sure workers have their medical and financial needs met when a workplace-related injury or illness happens. The program avoids having workers and employers go through the court system, which is risky for both parties: the employer and their insurer risk being held responsible for a large damage award, while the employee risks losing the case and ending up with nothing.

This simplified procedure works well when both parties agree that the worker deserves compensation. Things become much more complicated, however when the employer or insurer contests the worker's claim.


One problem with workers having their claims approved is that both the employer and their insurance company have a financial interest in denying a claim. When a claim is denied, the insurer saves money by not paying compensation to the worker. Because the employer's workers' compensation insurance premiums could go up if numerous claims are filed at their workplace, the employer has an incentive to keep approved claims to a minimum. For this reason, among others, contested claims are common.

When a claim is contested, the employer's insurer will give certain specific reasons for denying the claim, which might or might not be legitimate. They might say the denial is because the accident was not witnessed by anyone else, the injury was not reported in a timely manner, or you refused to make a recorded statement about what happened. An important point to remember is that insurers tend to ask for recorded statements only if they intend to deny a claim.


Once your claim is denied, the best response by far is to seek immediate consultation with a workers' compensation attorney. The procedure for dealing with a contested claim is complex and involves getting all of your medical records in order and lining up any witnesses and healthcare providers willing to testify on your behalf. You will then have to go before an adjudicator or workers' compensation board to plead your case. The average worker is unlikely to successfully navigate this process without an experienced workers' compensation lawyer at their side.

Contact a law firm that offers a workers' compensation attorney consultation to learn more.