What might prevent me from being able to recover workers’ compensation benefits for a workplace injury?

People who were injured on the job often count on workers' compensation benefits to cover related medical bills and provide temporary total disability payments until they are well enough to return to work. Workers' compensation is a system, created by the Delaware legislature, which has become by law automatically part of your employment contract and provides benefits to workers who are injured while working. Employers with one or more employees are required to carry workers' compensation insurance. The workers' Workers' Compensation and Barriers to Obtaining Benefitscompensation statute prohibits an employer from firing or, in any other manner, discriminating against an employee for filing a claim for benefits.

The Delaware Workers’ Compensation Law provides substantial protections and benefits to the injured worker. However, as with any law, it can be a very complicated process to muddle through. It is also an adversarial process, putting the injured worker in need of benefits against the workers’ compensation insurance carrier, which is interested in limiting benefits.

Workers' compensation benefits are paid by the employer or the employer's workers’ compensation insurance carrier. The benefits are outlined in Title 19 of the Delaware Code and are administered by the Office of Workers’ Compensation (part of the Delaware Department of Labor). These benefits include lost wages, medical care, permanency, disfigurement, mileage reimbursement, and death benefits. The insurance company for your employer is not required to advocate for you or to even inform you of some of the various categories of benefits that you may be entitled to. In addition, some of the benefit categories may be best pursued on a timetable unique to your case that needs to be chosen with your maximum recovery and long-term interests in mind. Disputes between you and your employer regarding benefits are handled by the Industrial Accident Board or “IAB.” The IAB is basically the court of first resort for workers’ compensation disputes.

However, despite the workers' compensation statute, there are still things that could jeopardize an injured worker's ability to recover benefits. Here are some of the most common reasons insurance companies give for denying workers' compensation claims.

The Injured Employee Waited Too Long to Notify Their Employer

After an on-the-job injury, workers must notify their employer in accordance with deadlines known as statutes of limitations.

It is critically important to appreciate that action needs to be taken quickly after a work-related accident or injury in order to preserve and secure benefits available under the statute. Indeed there are several time limits that may apply to the facts of each individual case. It is important to remember these issues are applied and decided in an adversarial process. The various and sometimes complex time limitations can and will be used by the employer’s representative or carrier as a weapon to deny the injured worker benefits that otherwise would have been available.

Generally, the time period in which an employee has to file a case with the IAB is two years from the date of the original incident, or five years from the payment of any benefit under the statute by the employer’s workers’ compensation insurance carrier. However, the limitations period is shortened to one year for occupational exposure cases. Occupational exposure cases include cases where the statutory definition of an “occupational disease” is met as a material component in the injury.

The best way to avoid having problems with deadlines is to make sure the claim is opened properly following your work incident. There are two documents which should be completed and filed with the IAB right away: (1) Agreement as to Compensation; and (2) First Report of Injury. While it is the responsibility of the employer and its carrier to see that these documents are filed with the Board, the insured worker should make sure this has been done. One of the advantages of being represented by an experienced workers’ compensation attorney is that your attorney acts as your watchdog to make sure that the employer and its carrier do what they are supposed to do.

Workers who fail to notify their employer before the statutes of limitations have expired forfeit their right to receive workers' compensation benefits for their injuries.

The Injuries Were Caused by Misconduct

Workers' compensation programs generally do not provide benefits to employees who were injured while engaging in willful misconduct. As a result, employees may be disqualified from receiving workers' compensation benefits for injuries that were:

  • Purposely self-inflicted
  • Unrelated to work duties
  • Sustained while under the influence of drugs or alcohol
  • Suffered during a physical altercation with a co-worker that stemmed from a non-work-related dispute

If intentional misconduct is determined to have played a role in a workers' compensation case, the employer's insurance company will decide if it was significant enough to warrant a denial of benefits.

The Injuries Happened Off-Site or Were Preexisting

Insurance companies try to reduce their financial obligation to injured workers whenever possible. One way they do this is by disputing the worker's claims about how and where the injuries occurred. For example, an insurance adjuster may claim that the injuries happened while the employee was away from the workplace and not engaged in work-related duties.

Another common insurance company tactic is to try to attribute the worker's injuries to a previous accident. For example, if a worker injured his shoulder in a previous bicycle accident and went on to injure that same shoulder at work, the insurance adjuster may claim that the majority of the discomfort is due to the original injury in an attempt to minimize his benefits.

Do You Need a Workers' Compensation Attorney?

It is always a good idea to consult an attorney about your workers’ compensation claim. The elements of your claim which the attorney will evaluate in considering whether you need an attorney include:

  1. Did the incident occur while you were within the course and scope of your employment?
  2. Did the work incident result in injury?
  3. Was the injury verified by a Board Certified Physician?
  4. Is this an accepted or contested claim?
  5. If it is a contested claim, are there reliable witnesses to the work incident, and certified expert medical witnesses willing to testify in support of the claim?
  6. If it is an accepted claim, has the claimant been paid all applicable benefits outlined above pursuant to the Delaware Workers’ Compensation Statute?
  7. Is the claim within the applicable statute of limitations?

If you were injured at work or diagnosed with an illness caused by your job, an experienced workers' compensation attorney can help address any potential barriers to recovery and fight to ensure you receive the benefits to which you are entitled. Do you have questions or concerns about your workers' compensation claim? Contact the Morris James Personal Injury Group today to schedule a free initial consultation.