Non-Compensable Claims Explained: A Guide for Employees
If you are injured in the course of employment in Vermont, you may be eligible to receive workers’ comp benefits. However, once you file your workers’ compensation claim, your claim may be denied. This is because, for a claim to be approved, several requirements have to be met to make your injury compensable. A compensable injury is one that meets the legal requirements for coverage under Vermont’s worker’s compensation laws. When your injury is determined to be compensable, it means that your employer’s insurance agrees that your injury was work-related and will pay for the necessary treatment.
On the other hand, a “non-compensable” claim is one that the insurance company denies, mainly because they believe the injury did not happen in the course of employment. Understanding what makes a claim non-compensable can help you determine whether to challenge a denial or if your injury falls outside workers’ comp coverage. Here’s what Vermont employees should know.
What Makes a Claim Non-Compensable?
A workers’ compensation claim may be considered non-compensable if it doesn’t meet the legal standards for coverage. Some of the reasons why your claim may be termed as non-compensable and therefore denied include:
- Your Injury Is Not Work-Related
For a claim to be compensable, your injury must have happened while you were performing work duties. Remember that this includes traveling for work-related activities. However, if you were injured during personal activities, like working out in a workplace gym, hiking on your day off, or while commuting to work, your claim may be denied.
- Late Reporting or Filing
Another reason your claim may be non-compensable is if you filed your injury late. Under Vermont law, employees must report work injuries immediately. If you wait too long to notify your employer or file a claim, the insurance might question whether the injury was genuinely work-related, leading to a denial. For example, if you suffer a back injury but only report the alleged incident to your employer three months later, the insurance company may deny the claim because of the delay.
- Violation of Company Policy
If you were injured while violating company rules, such as engaging in horseplay or working under the influence of drugs or alcohol, your claim is likely to be denied.
- Lack of Medical Evidence
If there’s no clear medical documentation linking your injury to your job, you have conflicting reports from doctors, or you are entirely lacking medical records, the insurer may refuse to cover your injury and losses.
What Does “In the Course of Employment” Mean?
To be eligible for worker’s compensation, an injury must have occurred in the course of the employment, meaning while performing job-related tasks. In Vermont, this may include the following:
- Injuries that happen while performing assigned duties at your workplace
- Work-related travel, such as deliveries or business trips
- Special errands for your employer, as long as it’s for business purposes.
However, as mentioned earlier, regular commutes to and from work usually do not qualify unless you were driving a company vehicle or on an approved work-related trip.
What To Do if Your Claim Is Denied?
If your claim is denied as non-compensable, don’t assume that the decision is final. You have the right to appeal, and a skilled workers’ comp lawyer can help you challenge the denial.
Legal Help Is Available
If your workers’ compensation claim has been denied or you have questions about your eligibility, contact our skilled Vermont workers’ comp lawyer at Sluka Law PLC at 802-457-1000 today to get the help you need.
Source:
aoa.vermont.gov/wcp/injury#:~:text=When%20should%20an,following%20the%20injury.
