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Watch for These Common Workers’ Compensation Defenses Insurers Use to Avoid Paying Claims

New York workers’ compensation is an insurance system that provides medical treatment and wage replacement benefits to employees who’ve sustained injuries or developed illnesses as a direct result of their employment. Because it’s a “no-fault” system, workers can often collect benefits even if they’re inadvertently responsible for the accident or their injuries.

Unfortunately, that doesn’t mean that obtaining the workers’ compensation benefits you deserve will be smooth sailing. Workers’ compensation insurers are businesses and they’d prefer not to pay out benefits to claimants if at all possible. To that end, they have a wide range of defenses they employ to try to reduce or eliminate their financial obligation.

Common Defenses in Workers’ Compensation Cases

Familiarizing yourself with these common defense strategies prevents you from being blindsided, and allows you and your attorney to build the strongest case possible.

Self-Inflicted Injury

Though you can collect compensation for accidental workplace injuries even if they’re your fault, deliberate, self-inflicted injuries—such as those inflicted for the purpose of filing a fraudulent workers’ compensation claim or resulting from a fight you started—are not compensable. If you were responsible for your injuries, your attorney can help you gather the evidence needed to prove they weren’t intentional.


Workers’ compensation doesn’t provide benefits for injuries caused by willful negligence. Your workplace has safety protocols in place for a reason. If you choose to flagrantly violate those rules, any injuries that result may not be compensable.


When it comes to New York workers’ compensation, horseplay is a bit of a gray area. You may be entitled to benefits based on the fact that your injuries arose out of employment and occurred during the course of employment. However, if your employer has strict, well-documented rules prohibiting horseplay, your claim could be denied.


If your injuries were solely caused by drug or alcohol intoxication, your employer and their workers’ compensation insurer could deny your claim for benefits. Although, the injuries may be compensable if other factors contributed to them.

Exaggerated Injury

If you exaggerate the severity of your injuries in order to collect workers’ compensation and the evidence doesn’t back your claims, your benefits could be reduced or stopped.

Injury Not Related to Work

Injuries must be directly related to work in order to be compensable. As a result, your employer may try to claim that you weren’t working when the injury occurred or that your occupational illness isn’t actually connected to your job.

Missed Deadline

You’re required to report your workplace injury or occupational disease diagnosis to your employer within 30 days. However, it’s best to notify your employer as soon as possible to start the claims process and ensure the preservation of important evidence. Additionally, injured or ill workers have two years to file a claim with the Workers’ Compensation Board. Missing these deadlines can cause you to lose your right to benefits.

How an Attorney Can Help

Here are just a few of the many things a skillful New York workers’ compensation attorney can do to help:

  • Gather important evidence
  • Take statements from witnesses
  • Handle all communications with the workers’ compensation insurer
  • Rebut these and other common workers’ compensation defenses
  • Negotiate on your behalf
  • File an appeal if your workers’ compensation claim is denied

Request a Free Initial Consultation

Don’t let an employer’s unfair defense tactics intimidate you into giving up your workers’ compensation claim. If your injuries or illness arose from—and occurred during the course of— your employment, you’re entitled to medical treatment, wage replacement, and other vital benefits. Let the accomplished New York workers’ compensation lawyers at O’Connor Law PLLC handle your claim from start to finish and ensure you receive the recovery you deserve.

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