An employee who files a claim for workers compensation benefits may have their claim accepted or denied. If the claim is found valid by the employer and is accepted, then the employee will receive appropriate workers’ compensation benefits (medical cost coverage, cash benefits to cover costs of living, and vocational rehab if necessary) while they recover from their injuries. If the claim is denied—as in, if the employer refuses to shoulder liability for the injury—then the employee has the option to file a lawsuit.
The Workers’ Compensation Appeals Board (WCAB) handles the process for workers’ compensation claims. When an employee’s claim is rejected by their employer, they may take their case to the WCAB in the hopes of having the Board declare their claim to be valid and to compel the employer to offer workers’ compensation to the injured employee. The Board takes in evidence and, if they determine that an employer was liable for the injuries the employee sustained, the employer may then need to give benefits to the employee. In short, an employee has little to lose by filing a claim with the WCAB—it is simply a matter of waiting to see if their gamble pays off. For the employer, on the other hand, the lawsuit can end up being costly.
Building your case against the claim takes time and effort invested in researching and investigating the circumstances surrounding the employee’s alleged injury. The process can also mean cash out of your pocket as you sacrifice part of your workday to attend the trial and argue your side of the issue. These drains on time and resources can be costly for the employer, and if the WCAB finds in favor of the employee, those costs could end up being all for nothing.
When applied properly, California’s workers’ compensation system benefits both employees and employers. For employees, it provides a consistent and fair means of seeking financial compensation for losses resulting from a workplace accident or illness. For employers, it ensures that employees can’t hold them directly accountable for on-the-job accidents by suing them.
However, across virtually all industries, there may be workers who attempt to take advantage of the system. You could pay the price in rising insurance premium costs if this happens at your company.
It’s important to be confident when rejecting a workers’ compensation claim. You want to know that your employees are receiving the benefits for which they’re eligible when they have valid reasons to seek said benefits. That said, there may be instances when you have legitimate reasons to deny workers’ compensation claims. The following are common examples:
It’s not uncommon for those committing workers’ compensation fraud in Long Beach to genuinely be injured. They’re simply not entitled to workers’ compensation benefits because they actually sustained their injuries outside of work.
Be aware that, depending on the circumstances, an employee could technically be on the premises of their workplace without necessarily being on the clock when an accident occurs. Even if an employee was physically at or near the location where they work, they might not be eligible to receive workers’ compensation benefits if they were not operating within the scope of their employment when they were injured.
Signs that an employee may be claiming they were injured at work when they were actually injured elsewhere or while off the clock include:
An employee doesn’t need to prove they were injured as a result of negligence to demonstrate that they’re eligible to receive workers’ compensation benefits. They only need to show that they were operating as an employee when they were injured to indicate that their workers’ compensation claim should be honored.
However, sometimes, employees are injured at work due to their own unreasonable negligence. This can happen if an employee was injured because they were intoxicated. If an employee caused their own injuries because they were under the influence of drugs or alcohol, they don’t deserve to receive workers’ compensation benefits.
Employees are expected to behave responsibly at work. An employee could negligently cause their own injuries if they were to engage in unreasonable horseplay in a work environment.
That said, it can sometimes be challenging to prove that an employee’s behavior qualifies as horseplay. This is one of many reasons to hire an attorney specializing in Long Beach workers’ compensation lawsuits if an employee disputes your reason for denying their claim. Our experts can help you provide evidence showing you were justified in denying an employee the workers’ compensation benefits they were seeking.
You do not want to attend the WCAB trial alone. It is crucial that employers seek out qualified legal counsel to represent them during a workers’ compensation lawsuit. Our attorneys have lengthy experience in practicing workers’ compensation defense law, and we have a long history of getting satisfying results for our clients, including corporations and small businesses. We can investigate the claim on your behalf, attend the trial, and argue in favor of your business’s best interests.
If your employee has filed a claim against you and you need a workers’ compensation lawsuit defense attorney in Long Beach, the expert attorneys at Sacks Law Group, APC is here to assist you. The trial process can be time- and resource-consuming for employers and employers have a host of other matters that require their attention on any given day. That is why hiring a skilled and experienced attorney to guide you through—and represent you during—the process is crucial. Contact us today for your consultation.