Should You Ever Deny a Workers Compensation Claim?

Hamilton Fox & Company Inc. helps Pinecrest FL businesses navigate the complexities of workers’ compensation, including the difficult decision of when to deny claims. While most workers should receive compensation for workplace injuries, there are instances where denial is warranted.

Understanding When Compensation Can Be Denied

Ordinarily, employees injured while performing their duties should not be denied workers compensation. However, not all injuries automatically qualify. Here are several circumstances under which denying workers’ compensation is justifiable:

  • Off-the-Clock Injuries: Injuries sustained while the worker is not on the clock, even if they are still on the premises, do not qualify for compensation.
  • Intoxication Injuries: If an investigation reveals the employee was intoxicated at the time of injury, the claim can be denied.
  • Horseplay Injuries: Workers’ compensation does not cover injuries from in-office fights or horseplay.
  • Travel Injuries: Unless job-related, injuries sustained while traveling to or from work do not qualify.
  • Non-Sanctioned Activity Injuries: Injuries from non-approved activities, such as an unauthorized basketball game at lunch, are ineligible.
  • Psychological Injuries: Psychological damage from minor incidents, such as a negative performance review, are not compensable.
  • Criminal Injuries: If an employee gets hurt while committing an illegal act on the job, including fraud, they’re not eligible for compensation.

Contact Hamilton Fox & Company Inc.

For support navigating workers’ compensation complexities, contact Hamilton Fox & Company Inc. Our expert team will ensure your Pinecrest, FL business maintains compliance while adequately protecting your employees’ rights.