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  • Writer's pictureRobert Schuerger

The Ugly Reality: Why Do Employers Fight Workers' Comp Claims?

An astonishing 2.8 million nonfatal workplace injuries and illnesses were reported in the U.S. in 2019, yet many wounded workers face challenges in receiving fair compensation.

Employers often resist workers' compensation claims for various reasons, ranging from financial concerns to company image protection.

In this article, employees can learn the intricacies of workers' compensation, the common reasons employers fight workers' comp claims, and insights into the complexities of the system.

Understanding the Workers' Compensation Claim Process

Understanding the Workers' Compensation Claim Process

The workers' compensation claim process involves awarding benefits to employees who suffer work-related injuries. It includes filing the claim, claim adjuster investigation, and the administration of benefits, such as post-injury rehabilitation and medical care.

After a workplace injury, the injured employee needs to report the incident promptly to their employer, as late reporting can lead to claim denial.

Moreover, in most states, workers must report the injury within 30 days of occurrence. Once reported, the worker will get an appointment with a physician and a claim adjuster to investigate the case.

During this process, employers may contest workers' comp claims for various reasons, such as disputing the injury's severity, location, or necessity for medical treatment.

To minimize conflicts, employees should follow due process regarding injury diagnosis and incident reporting and maintain records throughout the claim process.

Why Do Employers Fight Workers' Comp Claims?

Employers may fight workers' compensation claims for various reasons, including controlling insurance costs, discouraging other employees from filing claims, and protecting the company's reputation. It's essential to explore each of these motivations to better understand why employers contest claims.

1. Preserving the Company's Reputation

A company's image can be significantly impacted by a workplace injury, particularly if it stems from unsafe working conditions.

Admitting responsibility for an employee's injury could lead to negative public perceptions, which may affect the company's profits and stock prices. As a result, employers might contest workers' compensation claims to prevent potential harm to their reputation.

2. Discouraging Other Employees from Filing Claims

When employers fight workers' compensation claims, it may serve as a deterrent for other employees considering filing their own claims.

Witnessing the lengthy legal battles and possible denial of a co-worker's claim might discourage injured employees from pursuing compensation, thus reducing the number of filed claims.

3. Controlling Insurance Premiums

Workers' compensation insurance premiums are influenced by the number and cost of claims a company has faced.

Furthermore, when an injured employee files a workers' comp claim, the associated expenses, such as medical bills and lost wages, can increase the employer's insurance premiums. To keep the workers' compensation premium as low as possible, employers may challenge the claim.

Direct and Indirect Costs

Direct and Indirect Costs

When dealing with workers' compensation claims, there are two primary cost categories: direct and indirect. Both types of costs can have a significant impact on a company's financial health, so understanding the difference between them is crucial.

Direct Costs of Workers' Compensation Claims

Direct costs are easily identifiable and quantifiable. The most apparent direct cost for businesses is the workers' compensation insurance premium.

Employers pay an insurance coverage premium, and in return, the insurance company covers the workers' compensation benefits that injured employees are entitled to under state law. These benefits can include medical care, rehabilitation, disability benefits, and death benefits.

Additionally, the insurer covers any legal fees for the covered claims. Disability benefits generally reimburse injured workers for around two-thirds of the earnings they lose while they're unable to work, and employers are not entitled to pay wages to wounded workers receiving these payments.

Indirect Costs of Workers' Compensation Claims

Indirect costs are not as easily identifiable and quantifiable as direct costs. However, they can still have a significant impact on a company's finances. In many cases, indirect costs related to workplace injuries can surpass direct costs. Some examples of indirect expenses that can arise from a workers' compensation claim are:

  1. Decreased productivity among employees due to the absence of the injured worker,

  2. Additional administrative tasks for management and HR,

  3. Costs associated with training and hiring a temporary or permanent replacement,

  4. Potential damage to the company's reputation,

  5. Lowered morale and increased stress among remaining employees,

  6. Possible increases in workers' compensation insurance premiums, and

  7. Loss of business or clients due to reduced output or delays.

Dealing with the Complexities of Workers' Compensation Claims with Expert Legal Assistance

Suffering a work-related injury can be a life-changing experience. When an employee is faced with mounting medical costs and the inability to work, they may be entitled to workers' compensation coverage.

Why Do Employees Need a Lawyer on Their Side?

A workers' comp claim can provide much-needed relief by covering an employee's medical costs and a portion of lost income. However, the process of filing a workers' compensation claim is often intricate, with varying laws, procedures, and deadlines from state to state.

Furthermore, in such situations, it is highly beneficial to have the support of experienced workers comp lawyers in Houston, such as the team at Schuerger Shunnarah Trial Attorneys. The law firm goes to war for its clients, ensuring that they are well-represented in their pursuit of rightful compensation.

Its expertise can help clients better understand the complexities surrounding workers' compensation insurance and how to move forward with their claims. They can help with other questions like, "What is impairment rating?"

Benefits of Working with a Skilled Attorney

When filing a workers' compensation claim, it is not uncommon for the insurance company to challenge claims in an effort to minimize workers' comp premiums. In these instances, the guidance of legal professionals can prove invaluable, as the firm can help appeal denied claims and fight for the benefits its clients deserve.

An expert attorney can answer questions, explain the rules and procedures associated with the U.S. Department of Labor, and guide clients through the entire process.

By working with Schuerger Shunnarah Trial Attorneys, those faced with the daunting task of navigating a workers' comp claim can rest assured that they have a dedicated team on their side, advocating for their rights every step of the way. They can also answer questions such as, "What do workers comp investigators look for?"

Final Thoughts

Dealing with the complexities of workers' compensation coverage can be challenging for employees who have experienced a work-related injury.

Understanding the role of insurance companies, the complexities of filing a worker's compensation claim, and the factors that influence workers' compensation premiums is crucial for a successful outcome.

When in doubt, seeking assistance from professionals who are well-versed in workers' comp insurance is essential. Employees facing difficulties or in need of a free consultation can confidently turn to Schuerger Shunnarah Trial Attorneys for expert guidance and support.


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