Three Questions To Win Your Wrongly Denied Workers’ Compensation Benefits

It’s probably a safe assumption to say that most people don’t like their jobs.  You have to get up early, you have to wade through endless traffic just to get there, and then once you’re there you have to ACTUALLY do your job.  Hmm . . . it’s probably safe to say that most people don’t like working in general.  But it’s just one of those necessary and unavoidable evils in life that you have to grit your teeth and bear through.  That or, you know, just be homeless.  And that, in essence, is the reason we all work: to make money.  Because the only thing that sucks more that working is being broke.  Well, actually there’s another thing that can suck more than being poor, and that’s being this guy.

Not getting your workers’ compensation paid out by your company’s insurance carrier when you’ve been injured on the job is a nightmare that I wouldn’t wish on my worst enemy.  So I can’t imagine what it was like for Mark Lindquist (linked above) when he was literally impaled by a piece of metal and his company’s carrier, Accident Fund Insurance, refused to pay his medical bill.

Lindquist was a social worker who was caring for his three mentally challenged adult clients when a tornado hit his town in Joplin, MO.  Rather than flee, Lindquist did his duty as a social worker and followed his company’s policy by trying to take his clients to safety.  But he was stopped by a flying piece of metal through his chest and knocked unconscious.  Lindquist’s clients unfortunately died, but Lindquist himself was found buried in rubble by rescue workers and brought in for emergency care.

When he miraculously awoke he learned that he had been in a coma for two months, broken all his ribs and most of his teeth, and had rung up a $2.5 million hospital tab.  Accident Fund Insurance rewarded Lindquist’s valor by denying his benefits, claiming that he was in no greater danger than the general public and therefore didn’t deserved to be covered.

Don’t worry though, Lindquist’s story actually has a happy ending, or at least as happy as it can be considering Lindquist now suffers from memory and motor function loss, as well as the trauma of not being able to save his clients.  Accident Fund Insurance reversed their harsh stance after just one day of media scrutiny and decided to give him the full coverage he was due; but of course they did so without admitting any wrong doing.

But to me, the most ridiculous/scary part of this story isn’t necessarily what happened to Lindquist (as terrible as it was), but rather the fact that his story of workers’ compensation woe isn’t a rare or uncommon occurrence.  Carriers deny their legitimate coverage responsibility to customers all the time.

So what should you do if you find yourself in shoes similar to Lindquist?  Well, if your employer’s workers’ compensation carrier denies your benefits, you have some options to make them correct their mistake.  All you have to do is first ask yourself the following three questions:

1)      Is your injury one that is actually covered by workers’ compensation?

The first thing you need to ask yourself is whether the harm you’ve suffered is actually covered by your WC plan or by state law.  This is an important step in determining whether you were wrongly denied coverage, as an injury that doesn’t fall under this umbrella would obviously leave you without a leg to stand on, so to speak.

The extent of workers’ compensation coverage and laws can vary from state to state and company to company, but there are a few constants that you generally can rely on in figuring out your own eligibility.  Traditionally, injuries that occurred as a result of or in the course of conducting one’s employment duties are always covered by workers’ compensation insurance.  Some examples include: physical injuries and any mental trauma that follows, diseases contracted in the course of working, and injuries that develop slowly over time.  It’s also important to note that it doesn’t matter whether or not the employee themselves are responsible for causing their injury; to be an injury that is covered by workers’ compensation, the only requirement is that it’s truly a work-related injury.

2)      Did the injury happen as a result of employee wrong-doing or misconduct?

Yeah, I know this question seems exactly contrary to what I said above, but there’s actually an important distinction here worth mentioning.  Purely accidental or unintentional injuries are covered by worker’s compensation, even if it’s the employee’s fault.  However, what isn’t covered are injuries that an employee inflicts upon him or herself for the purpose of getting worker’s compensation.  Basically fraud, conduct that goes against company policy, and any other criminal behavior that results in an injury while on the job isn’t covered by workers’ compensation.  So don’t go jumping off bridges just to get an early retirement.

3)      Is the injured party an employee?

Finally, it’s important to note that only employees are covered by workers’ compensation.  Business owners, independent contractors, and unpaid volunteers aren’t covered by workers’ compensation insurance.  In addition, in many states, coverage doesn’t extend to farm, maritime, railroad workers, and even federal employees.  But be sure to read your carrier’s fine print to see how it fits in your case.

As you can probably see, Lindquist’s heroics fit exactly into these parameters and he was still denied his rightful benefits.  He was a social worker who was doing his job by protecting his clients from a tornado and as a result was impaled in the process.  It should’ve been case closed, but it wasn’t.

Insurance carriers can be pretty heartless when it comes to their bottom line.  So the moral here is that if your injury falls into the right place regarding the questions above, don’t be afraid to take your carrier to court and get what’s rightfully yours.  But more importantly, don’t be afraid to get the media involved.  Because the only thing all insurance carriers hate more than paying out benefits is losing money from bad press.

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