Has The Insurance Company Admitted Liability For Your Work Injury?

Oct 30, 2023 | Compensability, WC & Other Laws

Has the insurance company admitted liability for your work injury?- The most important thing we look for at the beginning of a case is if the insurance company has admitted liability on the case, have they admitted that it was in fact a work injury? And if they haven’t, we have to go to court and prove that our client did suffer an injury, and that fight is called compensability.

Admitted liability and proving it was a work injury

In order to get the benefits that they’re entitled to under the Workers’ Compensation Act, injured workers have to prove that they were injured within the course and scope of their employment.

Denial of liability

According to Workers’ Compensation divisions on audit, insurance companies deny 1/3 of the claims that come in. We don’t have to prove fault or extent of the injury, just whether or not the injury occurred at work, and yet it’s denied 1/3 of the time. What we have to prove is that it’s more likely than not that the injured worker did in fact injured themselves at work.

It’s good public policy for insurance carriers to allow injured workers to seek treatment upon asking for treatment, but that doesn’t necessarily mean that the carrier is going to admit liability for all the workers’ compensation benefits that can result from an injury.

The law says that just because the insurance company has paid for medical care does not mean it’s an admission that it is a work injury. We’ve seen cases where the carrier has paid for months of treatment and then they turn around and deny liability.

Types of work injuries

Most people think if it’s an on-the-job injury they will get covered, and it’s much easier if they were lifting something, or slipped and fell, but there are other situations where’s not that clear, like injuries where the person is off the clock, on a break, or leaving to the parking lot, or driving to and from work, and the rules are incredibly complex and sometimes contradictory.

Another kind of injury that people don’t necessarily understand may be covered and compensable is called occupational diseases, which you may get from doing repetitive things at work, from being exposed to different toxins at work that maybe one exposure doesn’t cause a problem, however being in the work environment for weeks, months or years does.