Filing a workers’ comp claim feels like it should be straightforward, right? You get hurt on the job, you file the paperwork, and then you get the support you need to recover.
Sadly, it doesn’t always play out that smoothly.
Insurance companies sometimes drag their feet, employers push back, or benefits just don’t come through like they should. That’s when people start thinking about suing the system.
Now, you usually can’t just sue workers’ comp directly because it’s designed to be the “exclusive remedy.” But there are situations where you can push back.
In this post, we’ll go over the most common reasons to sue workers comp.
#1 Claim Denial Without Good Reason
One of the most frustrating things is when your claim gets denied for no real reason.
You did everything right. You reported your injury, saw the doctor, filled out the forms… and then you get that denial letter in the mail. It feels like a punch to the gut.
Insurance companies sometimes deny valid claims just to save money.
Other times, they’ll say you missed a deadline or that your injury isn’t “work-related.”
If that happens, you don’t have to just accept it. You have the right to fight back. Appealing the decision or taking legal action can turn things around and get you the benefits you should’ve received in the first place.
Also Read: Favorable IME Report – What’s Next?
#2 Bad Faith By The Insurance Company
Insurance companies are supposed to act in good faith when handling your claim. That means investigating it properly, paying benefits on time, and not putting up unnecessary roadblocks.
But sometimes, they don’t play fair.
Examples of bad faith can include:
- Ignoring evidence that supports your claim
- Deliberately delaying payments
- Misrepresenting your medical records or injury details
If you’re dealing with tactics like these, it’s not just unfair, it’s potentially illegal.
Suing for bad faith is one way to hold the insurance company accountable and make sure you’re treated fairly moving forward.
#3 Retaliation From Your Employer
Another reason to sue workers compensation is employer retaliation.
Filing for workers’ comp is your right. You shouldn’t have to worry about how your boss will react. Unfortunately, some employers retaliate when employees file a claim.
Retaliation can look like firing you, cutting your hours, demoting you, or suddenly making your work life unbearable.
It doesn’t always happen right away either. Some employers wait a little before taking action, hoping it’ll seem unrelated to your claim. But the pattern is usually clear.
Also Read: Workers Comp Ruined My Life
This is against the law. If your employer punishes you for exercising your rights, you may be able to sue them.
Retaliation cases send a clear message: you can’t bully employees out of getting the benefits they deserve. Plus, by standing up for yourself, you also protect others at your workplace.
#4 Third-Party Negligence
Not all workplace injuries are 100% your employer’s fault.
Sometimes, another party is to blame.
Maybe you were injured by faulty equipment. Maybe a delivery driver hit you while you were on the job. Or maybe a subcontractor’s mistake led to your accident.
When that happens, you can file a workers’ comp claim and a lawsuit against the third party.
These cases can be really important because workers’ comp benefits don’t always cover everything, like pain and suffering.
A third-party lawsuit can help you get full compensation for what you’ve been through.
#5 Inadequate Medical Treatment Approval
Your doctor says you need treatment. The insurance company says, “nah, you’ll be fine with less.” That’s a classic workers’ comp headache.
Insurers sometimes deny or cut back on recommended care to keep their costs down.
The problem is, when treatment gets delayed or watered down, you’re the one who pays the price. Instead of healing, you might get stuck dealing with ongoing pain, limited mobility, or even long-term complications that could’ve been prevented.
If the insurance company refuses to approve what your doctor recommends, you can challenge that decision.
In extreme cases, you can sue them if their refusal is unreasonable and harmful..
#6 Misclassification Of Your Injury Or Employment
Some employers play games with classifications.
They might try to label you as an independent contractor instead of an employee so they don’t have to provide workers’ comp. Or they might downplay the severity of your injury, calling it something minor when it’s actually pretty serious.
Both of those moves are ways to avoid responsibility.
And both can hurt you financially and medically.
If you’re misclassified, you lose access to benefits that should be yours.
Suing workers comp’ over misclassification forces your employer to take responsibility and cover your claim the way they should have from the start.
Also Read: What Is the Average Workers’ Comp Settlement for Surgery?
#7 Settlement Disputes
Sometimes you and the insurance company agree on a settlement to close out your claim.
But what happens when the amount they offer is way too low? Or they drag out negotiations, hoping you’ll just take whatever’s on the table?
That’s when disputes happen.
And if they can’t be resolved through negotiation, the next step could be legal action.
Suing over a settlement dispute can make sure you’re not pressured into accepting less than you deserve. With the right help, you can push back and secure a settlement that actually covers your needs, both now and in the future.
Final Thoughts
Workers’ comp is supposed to be a safety net. It’s there to protect you when you get hurt. But when the system doesn’t work the way it should, you don’t have to sit back and accept it.
Claim denials, retaliation, shady insurance tactics – these are all situations where standing up for yourself is the right move.
Suing worker’s compensation might sound intimidating, but sometimes it’s the only way to make things fair again. If you’re dealing with one of these issues, talking to an experienced workers’ comp attorney can help you figure out the best path forward.
At the end of the day, it’s about protecting your health, your job, and your future.
