When Your Employer Denies Work Comp Claim

Even if you are responsible for a work-related accident, your employer should still cover your medical expenses and time away from work.

weight-scaleIn return, the employer is exempt from any personal injury lawsuit you may consider filing. Even so, it is not uncommon for the insurance carrier for the employer to try to find cause not to pay benefits. Since injuries that overwhelmingly occur from outside influences are not compensable, any type of condition, even obesity, may be presented as the true cause for your injury. If this is the case for your workman’s compensation claim do not despair. A qualified St. Louis work accident lawyer should be able to set things straight and help you receive the compensation you deserve.

An Employer Denies Benefits Based on Weight of Employee

A Missouri furnace operator was denied his benefits for carpal tunnels syndrome after years of working with a mechanical jack-hammer. There was major dispute with how many hours a day this activity was performed. Reports show that employees who work with such machinery for more than thirty minutes a day are subject to developing the condition. Employee testimony, including that of a witness, stated that he was required to work the machinery for hours during his shift, a direct contradiction to the employer’s contention of under fifteen minutes.

Medical Expert Witnesses

Medical testimony was also provided by both parties;  each gave a different version of how the condition was caused. While the employee ascertained that the injury was a result, not just of the jack hammer, but also of the heavy lifting and other duties he performed, the employer’s expert physician tried to place the blame on his body mass index. This was refuted by the employee’s physician who pointed out that there is little to no fat inside of the carpal tunnel, so a patient’s weight would have no bearing on it.

The panel agreed with the employee and ordered that the insurance company resume benefits immediately, including paying for the treatments they had previously denied and all future care. Since MMI had not yet been met, the board also kept the case an open one until the final award for disability could be determined.

Preserving Your Rights

A case like this shows to what lengths an insurance company will go to avoid expensive treatments. St. Louis work accident attorneys are well aware of all these tactics and have the means to help you defend against them. If your health could in any way be a prevailing factor for your injury, the employer will use that to his advantage.

Having to bring your claim to the attention of the board is not an easy task. As you can see, the outcome relies heavily on evidence presented, just like in a civil trial. In order to preserve your rights and ensure your compensation is recovered, call The Law Office of James M. Hoffmann at (314) 361-4300.

Photo credit: dsearls via Flickr

Updated: March 28, 2018