What If Insurance Says the Work Accident Was My Fault?

There are few injuries more stressful than injuries that keep you from making a living. Thankfully, the workers’ comp program exists to help injured workers continue providing for their families while they recover. Whether you were injured on the job because of an accident or inhaled toxic fumes, workers’ compensation usually covers all on-the-job injuries. This usually includes medical bills associated with the workplace injury and compensation for missed days due to the accident.

So what injuries disqualify you from receiving workers’ compensation benefits?

Why Does the Insurer Say I’m Ineligible for Workers’ Compensation?

Although employers are required by law to offer workers’ compensation for all work injuries, there are specific cases that can be denied. The Georgia State Board of Workers’ Compensation lists employee responsibilities that must be abided or there is a possibility that your claim may be denied.

If your insurance states that the accident was your fault, check below to see if you have breached some of the requirements listed in the Georgia State Board of Workers’ Compensation form:

  • You should follow written rules of safety and other reasonable policies and procedures from your employer
  • No compensation shall be allowed for an injury or death due to the employee’s willful misconduct
  • If an employee unjustifiably refuses to submit to a drug test following an on-the-job injury, there shall be a presumption that the accident and injury were caused by alcohol or drugs. If the presumption is not overcome by other evidence, any claim for workers’ compensation benefits would be denied.
  • If you believe you are due benefits and your insurance carrier/employer denies these benefits, you must file a claim within one year after the date of last authorized medical treatment or within two years of your last payment of weekly benefits or you will lose your right to these benefits

Unfortunately, if you have breached the employee responsibilities listed above, it is unlikely that your insurance or employer will compensate you for your injury. It is vital to follow these rules to ensure your safety at all times and that you receive workers’ compensation if you did experience an injury on the job.

If you didn’t breach your responsibilities as an employee but were denied anyway, contact our workers’ compensation attorneys. We will be there to answer all your questions and help you determine your options.

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