Why Workers’ Comp Claims Get Denied in Roofing Accident Cases

It’s pretty obvious that roofing is a dangerous profession. Working with power tools at great heights on sloped surfaces in all types of weather—it’s often a recipe for disaster. Roofers commonly suffer from devastating back and neck injuries, broken bones, and potentially deadly brain damage.

Yet despite all this, many injured roofers learn that their workers’ compensation claim has been denied. How can this happen? Every claim is based on unique elements, so we can’t give a single answer that fits all situations. If you contact us for a free consultation, we can review your circumstances and answer your specific questions. To help you understand the issues that may arise, here are some factors that can lead to workers’ compensation claims for roofing accidents being denied.

Roofers are Often Misclassified as Independent Contractors

The workers’ compensation process in North Carolina is a compromise program for employers and employees. Injured employees can receive medical care and wage benefits without having to prove that their employer was negligent. But these employees cannot receive nearly as much compensation as they would if they filed a personal injury lawsuit and proved that their injuries were caused by the employer’s negligence. 

The system appears to offer certainty in exchange for reduced compensation. In reality, proving a workers’ comp claim is often nearly as difficult as winning a personal injury lawsuit, so employees often don’t have an easy route to recover compensation after a work injury.

Benefits offered through the workers’ compensation program are only available to workers who are classified as employees. If a worker is instead considered an “independent contractor” who works freelance, then the program does not apply.

Companies generally prefer to classify workers as independent contractors rather than employees when they think they can get away with it. This saves them money on accounting and payroll taxes, and they also save money by not paying for workers’ compensation insurance for those employees. So many times, workers hurt on the job try to file claims for workers’ compensation only to find out that they are not eligible for benefits because they are not considered to be employees.

Quite often, however, employers violate the law when they classify workers as independent contractors. A worker may be independent for tax purposes but still be considered an employee under workers’ compensation laws. When determining whether a worker is actually an employee, the North Carolina Department of Labor considers factors such as how much control the worker has over the way the work is performed, whether the worker can set their own schedule, whether the worker provides their own tools, and whether the worker offers similar services to other companies as an independent business entity. 

It does not matter whether the worker is labeled a “contractor” or is paid like a contractor. The actual daily work situation is what counts. If the roofing company supervises the work, sets the schedule, and provides the tools, then it is highly likely that the workers should be classified as employees eligible for workers’ compensation benefits. But it often requires an attorney to present intensive arguments to demonstrate this eligibility.

Lack of Workers’ Compensation Insurance

Just because North Carolina law requires employers to provide workers’ compensation coverage for their employees doesn’t mean that all companies actually comply with the requirement. Some companies try to cut corners by skipping coverage—particularly if they’ve misclassified employees as independent contractors. In certain situations, companies may be exempt from workers’ compensation requirements.

In these situations, an experienced personal injury lawyer who handles workers’ compensation claims and personal injury lawsuits can help the injured worker determine the best course of action to recover full compensation. Then the attorney can work to secure the maximum compensation available.

Disputes Among Contractors and Sub-Contractors

The construction industry and roofing business frequently involve work sites, whether one company is contracted to perform a job and that company then engages other companies to supply workers to complete specific tasks as part of that job. When a worker is injured on the site, contractors and subcontractors may fight over who is obligated to cover the worker’s injuries or who is responsible for causing them. The legal battle over this often leaves the worker stuck in the middle, waiting helplessly for assistance. An attorney can ensure the worker’s rights are protected throughout the legal process and that the worker receives medical care and assistance.

The Worker May Be Accused of Misconduct

A worker can legitimately be denied benefits if the injury results from certain types of misconduct. For instance, if someone is hurt because they deliberately disobeyed rules or tried to cause harm, then the insurance company might be justified in denying the claim for benefits. 

In some cases, recklessly goofing around on the job could be considered misconduct sufficient enough to deny benefits. However, if an employee is hurt because they made an ordinary, careless, or negligent mistake, then that would not be appropriate grounds to deny the claim.

Other Reasons for Denying a Claim

The insurance companies that are supposed to provide benefits to injured workers will often try to use any argument they can to avoid paying a claim. They might insist that the worker failed to provide proper notice to the employer or that the injury was caused by an event outside of work. When a claim is denied unreasonably, a dedicated workers’ compensation attorney can work to present the evidence and arguments necessary to succeed in obtaining benefits through the appeals process.

Find Out How Martin & Jones Can Help After a Roofing Accident

It can be hard to know what to do after an on-the-job injury. If you take the wrong steps, you could lose access to wage and medical benefits. Advice and assistance from a knowledgeable workers’ compensation attorney can make the recovery process much easier and help prevent mistakes that could delay or deny your claim.

If you need assistance filing a claim for benefits or appealing a denial of your workers’ compensation claim, contact the experienced attorneys at Martin & Jones for a free consultation and case evaluation. You can call us at 800-662-1234 or contact us online to get started.