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Top Reasons Workers’ Compensation Claims Are Denied

Were you injured at work and now find you are unable to return to work? For those who answered “yes,” to this question, the next step is to file a claim to receive workers’ compensation benefits. However, there are several reasons your claim may not be approved. If your claim is denied, though, it does not mean it is the end of the road.

If you have recently been denied your benefits or if you have been injured and don’t know what the next steps are, hiring a workers’ compensation attorney like the team at zavodnicklaw.com is a smart move. It is also a good idea to get to know the most common reasons that claims are denied, which are found below.

You Failed to Notify Your Employer in a Timely Manner

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You must report an injury to your employer when it occurs. If you fail to do this, several factors may come into play that makes it easier for the insurance company to try to deny your claim.

For example, if you do not tell them right away, they may not have the time or ability to investigate the accident right away because of the amount of time that has passed. In some cases, the insurance provider for the workers’ compensation injury may state you did not suffer the injury while at work or in the course of your job. They make this conclusion because if you are injured, you would report the incident immediately.

The Injury Did Not Take Place During Typical Work Activities

Source: activephysiohealth.com.au

If the injury you experienced did not happen while you were at work, you will not be able to receive benefits, in most situations. However, there are some grey areas related to this ruling. For example, if the injury took place during a work event or even while you were on break, there are some factors that will come into play and need to be considered.

You Did Not Visit the Right Medical Provider

Source: hoffmannworkcomp.com

Your employer, along with its insurance company, has the right to provide you with a list of doctors who are approved to provide you with treatment. The problem with this is that the doctors on this list may not always have your best interest top of mind when it comes to your claim. You also have the right to select your own doctor, too. If you find competing options from these two sides, it is a good idea to hire an attorney immediately.

There Is a Pre-Existing Injury Involved

Source: hensleylegal.com

If you have a pre-existing injury or condition, the insurance company may use it to deny your claim. However, there are many work injuries that will make a pre-existing condition worse than before, which means you are now in a position where you are unable to work when you could before. This, like many other scenarios, is a good example of when it is smart to get an attorney involved.

No Supporting Medical Records

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If you have not received any medical treatment related to your work injury, the insurance company may state that the injury did not exist when you claim it happened. Also, if you are laid off between when you are injured and when you file the workers’ compensation claim, it may be said that it as a cause and effect situation, and not related to the injury you experienced.

The best way to make sure your claim has the best chance possible of being successful is to get to a doctor right away. Keep in mind though, the doctor you choose to provide care for your work-related injury matters, as previously mentioned.

The Paperwork Was Not Filed in a Timely Manner

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Along with reporting the injury to your employer and taking the other necessary steps, it is essential that you file the paperwork in a timely manner if you want to file a workers’ compensation claim.

If you happen to miss the deadline or timeframe, you may have the validity of your claim questioned by the company providing workers’ compensation coverage to your employer.

The Injury Took Place Outside of Typical Job Duties

Source: quaysolicitors.co.uk

If you suffer an injury because of horseplay, a fight, or some other type of work-related action, then your claim will probably be denied. Also, depending on the investigation that is done of this incident, it could be misreported by the company. So if the claim is denied, it is only going to be legitimate, if this is what caused the injury at work.

You Can’t Explain Your Injury

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During the regular grind of a typical workday, you may suffer an injury and not even realize it immediately. This makes it difficult to determine why and when the injury actually took place. While this is true, it does not mean you are not allowed to file a claim.

Your Employer Has Disputed the Claim

Source: heuserlaw.com

While this goes along with some of the other reasons listed above, the truth is, an employer may dispute a claim that has been filed. This is why it is so important that you report your injury immediately and that you begin the process to receive the compensation you deserve.

If there were any witnesses to your injury, they should be included in your initial report to minimize the likelihood that this will happen.

You Didn’t Hire a Workers’ Compensation Attorney

Source: zuniclaw.com

Regardless of the situation, having a workers’ compensation attorney involved as early as possible is essential to have the claim approved. If you have been denied, an attorney will also help you review the claim and set you up for approval.

You Can’t Afford to Make a Mistake

When it comes to filing for workers’ compensation following a workplace injury or accident, you need to make sure you have a plan. You must also know what mistakes you should avoid.

Hiring an attorney is also a smart move, as this is going to help ensure the desired results are achieved. While there are no guarantees when it comes to workers’ compensation, knowing what to do and what to expect is crucial.


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