Legal Guide

Common Reasons Workers' Comp Claims Are Denied

While most people are able to get through their workdays safely and without any issues, accidents do happen from time to time. In some cases, these accidents could lead to injuries that will result in long-lasting pain, medical bills and the inability to return to work. If this does occur to you at work, you should be entitled to financial support through workers compensation insurance provided by your employer. Unfortunately, workers compensation claims are denied from time to time. There are several common reasons why these claims could be denied. 

You Did Not Received Medical Care

In most situations, a workers compensation claim will be approved if someone is injured and healthcare workers agree that it will prevent them from working for a period of time. If you were injured and never went and sought this care, it could make it hard to have the claim approved. Due to this, it is always important to see a doctor following a workplace injury. Not only will you receive any necessary care, but it can also provide the evidence needed to support your claim. 

Your Claim Was Not Filed Quickly

If you are injured at work, it is always best to seek medical attention immediately and report it to your employer. Depending on where you live, your ability to be covered by workers compensation insurance will depend on how soon after the accident you report your injury. If you do not report your injury quickly, the employer and workers compensation employer may assume that you were not actually hurt. If your injury is going to affect your ability to work, you should send a written notice to your employer and file the necessary paperwork as soon as possible. You should also make sure that you retain a copy of your notification for future reference.

Nobody Witnessed Your Injury

Depending on where you work, there may be many other people around you at all times. If this is the case, there likely will be a witness if you are injured while working. However, there are other work environments where you will spend more time alone or could get hurt with nobody else around. If there is not a witness around when you are hurt, it could make receiving workers compensation insurance more of a challenge. Due to this, you should ensure that you notify other people immediately if you are injured while on the job.

Drugs or Alcohol in Your System

When you are working, it is presumed that you will have a clean mind that will allow you to make good judgment. If you have drugs or alcohol in your system, it could lower your inhibitions and make a chance of an accident happening more likely. When you come to a hospital following an accident at work, there likely will be blood work taken. If it shows that you had taken drugs or had alcohol in your system, it could jeopardize your workers compensation claim. Some insurance providers will deny claims in these situations automatically and will wait to discuss the situation during the appeals process.

Inconsistencies in Documents and Statements

When a workers compensation claim is filed, the insurance company will do some work to validate all of the information that they have received. This part of the process will involve reviewing your statement, witness statement, accident and injury reports and medical reports received from the hospital. One of the main things they will want to confirm is that all of these pieces of information are consistent and conclude that an accident did take place that resulted in an injury. If there are some inconsistencies in the statements, they may be hesitant to approve the claim initially.

You or the Employer Does Not Fully Cooperate with Claim

Another reason that a claim could be denied is if the insurance provider does not receive cooperation from the parties involved. Most of the time, the workers compensation insurance provider will ask that you sign a form that allows them to access medical records and other information relative to the case. They may also try to obtain data from your employer that will help them assess the claim. Technically, nobody is required by law to provide this cooperation. However, if you don’t, it may make fully assessing your claim harder. This could delay the process or could result in your initial claim being denied.

Workers compensation insurance is designed to protect people that are hurt while working. If you were hurt and need to file a workers compensation claim, or you have had a prior claim denied, you need to have proper legal representation by your side. There are several factors that could cause your claim to be denied. Even if your claim is denied, the process is not necessarily over as you can appeal the decision. If happens to you, Steven H. Heisler, a premier personal injury attorney, can help you fight this decision to ensure that you receive the support that you deserve and that you are properly represented. 

comments powered by Disqus