Why workers’ compensation claims are denied

According to the workers’ compensation laws of Texas, workers who become injured on the job and meet requirements deserve compensation in the form of wage loss and medical benefits. However, the process of obtaining benefits is more complicated than the straightforwardness of the law would suggest.

One reason for denial of a workers’ compensation claim is that it is unclear if the injury is a result of work-related activities. This is especially true in the case of repetitive-use injuries such as carpal tunnel syndrome. According to the Mayo Clinic, there is not enough consistent scientific evidence to establish typing, assembly line work or use of vibrating tools as a direct cause of carpal tunnel syndrome.

According to FindLaw, if the worker intentionally injured himself or herself, the court is likely to deny a workers’ compensation claim. Similarly, if a worker’s behavior contributed to the injury, e.g., the worker performed the work while intoxicated, that may also be grounds for denial of the claim.

The court may also deny a workers’ compensation claim if the worker is not an employee. For example, independent contractors are not classified as employees and therefore cannot file valid workers’ compensation claims against a company with which they have a business relationship. Depending on the state, certain employees are also not eligible for workers’ compensation.

However, an employee does not necessarily need to accept the denial of his or her claim to workers’ compensation benefits. There is an appeal process in place for those who believe they filed a valid claim and deserve compensation.