Excuses Insurance Companies Use to Limit Workers’ Comp


When you’re injured at work, one of the greatest obstacles between you and your workers’ compensation benefits is your employer’s insurance provider. They’ll use a number of tactics to try to reduce or deny benefits, so it’s best to be on the lookout for the excuses detailed below.

1. You Weren’t on the Clock

Sometimes, an injury happens either just before you clock in or right after you clock out for the day. The insurance company may try to use this as grounds to deny benefits, but in Illinois, being off the clock isn’t an immediate disqualification from workers’ compensation.

For instance, suppose you have clocked out for the day and a coworker asks for your help lifting something. If you hurt yourself in the process of helping your coworker, your injury can still be covered because your actions still benefit your employer.

Put simply, if you are injured in the course of performing work-related duties—even if you are technically off the clock—your injury can still be covered.

2. It’s a Preexisting Injury

Some work accidents may aggravate a previous or existing injury. The insurance company may try to use this as grounds for reducing or denying benefits, in some cases by claiming that you weren’t injured at work at all—it was all just your preexisting condition.

Even if you have a preexisting condition, if a work accident causes it to flare up or otherwise makes symptoms worse, you are entitled to compensation for that change in your well-being. It won’t cover the original injury, of course, but you can cover any expenses and time off work due to your increased pain and physical limitations.

3. The Injury Isn’t That Serious

Often, insurance companies will try to downplay the seriousness of your injury. They use a wide range of tactics to do so, from independent medical examinations (IMEs) to surveillance. If they can prove in any way that your injury isn’t as serious as you claim it to be, they may be able to reduce your benefits.

As such, it’s vital to follow doctors’ orders when recovering from an injury. Failing to do so may make it seem like your injury isn’t as serious as you claim. In addition, when you are injured at work, report it as promptly as possible. Delaying could make it seem like you aren’t that badly injured, thus reducing the credibility of your claim.

4. It Didn’t Actually Happen at Work

One final tactic insurance companies use is to try to state that your injury didn’t actually happen at work. Often, work injuries are difficult to prove since you could be the only person to witness your accident. It gets even harder if it’s a repetitive strain injury since there’s no singular incident to point to.

Again, reporting your injury as soon as possible is key here, as is seeing a doctor. Your doctor’s assessment of your injury can help you prove that your injury is connected to a work accident, improving your odds of receiving benefits.

Dealing With the Insurance Company in a Workers’ Comp Case

If you face opposition from your employer’s insurance company when pursuing workers’ compensation, your best bet is to find a competent workers’ comp lawyer to represent you. Between legal representation and the above pointers, you’ll be in a better position to secure the benefits you need after a work accident.

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