Every year, thousands of workers across the U.S. suffer injuries on the job. Unfortunately, many of them struggle to get the compensation they’re legally entitled to. Even valid workers’ compensation claims can be denied if employers or insurance companies find ways to cast doubt.
In 2023, 9.7% of disabling claims were denied in Oregon. That means almost 1 in 10 injured workers were told they didn’t qualify for benefits. These are claims involving conditions that prevent someone from returning to work for an extended period of time. Understanding why these denials happen, and how to fight them, can make all the difference.
In this article, we explain 9 common employer defenses that employers and insurers use to deny workers’ compensation claims. By understanding these common defenses against workers’ comp, you and your lawyer can build a solid case to get you the benefits you deserve.
1. Medical Causation
Historically, medical causation has been one of the most common employer defenses used to deny a workers’ compensation claim. Under 656.005(7), a work injury is only compensable if it happens during the course of employment. But if that injury combines with a preexisting condition, the rules become stricter: the worker must prove that the work-related injury was the major contributing cause of the combined condition. This higher standard makes it easier for employers to dispute claims, especially when medical history is complex or unclear.
This was the legal grounds for denial in the case of Kirby v. SAIF, 214 Or App 123 (2007). In this case, a worker experienced pain after experiencing violent jolting movements while riding as a passenger in a truck. He filed for workers’ compensation after the incident, citing new symptoms in his neck and arms. An independent medical examiner found that while the work incident did aggravate his symptoms, an earlier injury and surgery he sustained several years prior were the major cause of his condition. The jolt in the truck was considered only a minor contributor and his claim was denied.
If you have a preexisting condition, your employer may argue that your work injury wasn’t the major cause of your current disability or need for treatment. Depending on your circumstances, you and your lawyer may be able to prove that you should not have sustained the injury despite any preexisting conditions.
2. Self-Inflicted Injuries
In rare circumstances, employers may claim that their injured employees intended to get hurt just to collect benefits. It’s a serious accusation, and one that is difficult to prove and rarely upheld in court. You may see this kind of defense with claims where the employee has a somewhat low income, but it can occur with any kind of workers’ compensation claim.
These kinds of denials stem from the employer wanting to pin fault on the employee to void the case. It’s important to note, however, that the burden of proof is high for employers. Courts expect clear evidence of intentional harm, which is extremely uncommon.
3. Negligence or Failure to Follow Rules
Sometimes accidents happen when a worker slips up. Maybe you forgot a step in a safety procedure or were momentarily distracted. Employers may argue that an employee’s own careless actions are what caused an injury. This includes not adhering to safety rules, or simply operating machinery carelessly. As a result, the employer did not cause the problem and should not be liable for it.
If your claim is denied for this reason, you’ll have to prove that you did not behave negligently before sustaining injuries. Also note that Oregon law doesn’t automatically deny compensation just because a worker made a mistake.
For example, in Sheldon v. U.S. Bank, 364 Or 831 (2019), the Oregon Supreme Court made it clear that unexplained workplace injuries, like a fall, can still be compensable even if the cause isn’t clear or could involve minor missteps.
4. Horseplay
“Horseplay” is when an employee engages in unprofessional or playful behavior that leads to injury. Essentially, if you acted rowdy or clowned around before the injury occurred, your company may point the finger at you instead of giving you the compensation you deserve.
If your employer uses this defense, they’ll need to prove that your behavior was both unsafe and unrelated to your work duties. You’ll have to either attest that your actions were professional, or you’ll have to verify that you should have been safe no matter how you acted. If the injury could have happened regardless of your behavior, your claim may still be valid.
5. Intentional Misconduct
This defense is more serious than negligence or simple horseplay. It applies when an employer believes you knowingly and willfully broke safety rules. Examples of this kind of misconduct include ignoring posted warnings, bypassing locked-out machinery, or actively defying training protocols.
With this defense, employers argue that you knew the risks and chose to ignore them, which makes your injury your own responsibility. But even then, they must prove that your actions were deliberate and not just reckless.
You’ll need the help of a lawyer to refute this claim as well so no obstacles stand between you and your compensation. The bottom line is that there’s a big difference between breaking a rule on purpose and making a mistake. Oregon law recognizes that difference and so should your employer.
6. Intoxication
Alcohol and drugs undermine one’s motor skills and depth perception leading to accidents and injury. As per 656.005(7)(b)(C), Oregon law allows denial of a workers’ comp claim if intoxication was the major contributing cause of the injury.
Using this defense, employers sometimes try to say that you were injured because you were under the influence. But here again, the burden of proof is on your employer. Suspicion is not enough and they must prove that you were intoxicated.
Your attorney can request toxicology results or medical evaluations to challenge this defense. With blood tests and other forms of proof, they can argue that your actions weren’t impaired, or that your impairment wasn’t the primary cause of your injury.
7. Failure to Notify Employer
In Oregon, when you’re injured on the job, you must notify your employer within 90 days. If you wait longer than that, the court may deny your claim. However, if a coma or other severe debilitation kept you from reporting the accident, you can prove that you lacked the ability to tell your employer on time.
This defense is easy t o avoid by simply notifying your employer, in writing, of your injury. Make sure to include information about when, where, and how the injury occurred.
8. No Medical Attention Was Received
If there are no medical records of your injury, your employer may argue that you were never really hurt or that your injury wasn’t serious enough to be covered. That’s why it’s critical to seek medical attention after a work-related injury if you plan on filing for workers’ compensation.
When you see a physician about your injury make sure they help you fill out Form 827, “Worker’s and Health Care Provider’s Report for Workers’ Compensation Claims,” if you’re in Oregon, or your state’s equivalent form.
Given all that, some injuries take time to worsen, and many workers try to push through the pain. Even still, documentation is key. If you didn’t get care immediately, work with a workers’ comp attorney who can help you explain the delay and work with your healthcare provider to create a medical timeline that connects your injury to your job.
9. No Connection to Employment
Employers may argue that your injury didn’t happen “on the job.” This could happen if you were off-site, on a break, or in a gray area like a parking lot or walking to work. Maybe you were injured at a company party. Or maybe you slipped on an icy sidewalk walking into your office. In these kinds of situations, you will have to prove that your injury was the result of something your employer did. Otherwise, they may posit that your injury happened due to outside factors, not something work related.
This was the defense used in Wiley v. SAIF, 337 Or App 63 (2024) when a worker was hit by a car while crossing the street to get to work. SAIF, the insurance provider, denied the claim under the “coming and going” rule. This rule states that an employee’s workday begins when they arrive at their workplace and ends when they leave at the end of the day. However, the Oregon Court of Appeals sent the case back, stating that the employee had to park across the street because there weren’t enough parking spaces in the employer’s lot.
If this happens to you, don’t let your employer claim your injury wasn’t work-related without a fight! As the case above proves, courts recognize that employer-created risks extend beyond the four walls of the job site.
How to Protect Yourself Against Employer Defenses
To receive benefits, you need to prove two things: that your injury happened at work, and that your work was the primary cause. Here’s how to protect yourself to avoid facing one of these defenses against workers’ comp:
- Notify your employer, in writing, of your injury as soon as possible.
- Document everything related to your case, including photos, incident reports, and medical records.
- Get witness statements about the accident, if possible.
- Do not post about your injury on social media as social media posts can be taken out of context.
- Hire a workers’ compensation attorney early as they know the tactics employers use and can help you defend yourself.
Read more: What To Do After You Get a Work Injury in Oregon
Fight Back Against Workers’ Comp Denial
The workers’ compensation system is meant to protect employees, not punish them. Unfortunately, many valid claims are challenged and denied. Don’t let that happen to you. Make sure you understand your rights and common employer defense strategies.
If your Oregon workers’ compensation claim has been denied, we’re ready to help. Our team will listen to your story, evaluate your case, and fight to get you the benefits you deserve. And you don’t pay us unless we win.
Reach out today to schedule a free consultation. Let’s build your case and get your claim back on track.
Mike grew up in a military family and attended Northwestern School of Law in Oregon, where he graduated with honors. He began practicing workers’ compensation law in 1991 and became a founding partner of Ransom & Gilbertson in 1995. With decades of experience, Mike is known as a top 1% workers’ compensation attorney and has earned Martindale-Hubbell’s highest AV rating for skill and ethics. Outside the office, he enjoys rafting, fishing, going to the beach, and spending time with his dog, Sahalie.