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Top 10 Reasons Workers’ Compensation Claims Get Denied

May 5, 2018

Top 10 Reasons Workers’ Compensation Claims Get Denied

If you’ve been injured at work and are now unable to work, you have the right to file for workers’ compensation. But, due to various reasons, not all of these claims are approved.
You should know that a denied claim in not the end of the road. If you’ve already been denied, or have been injured and are unsure of the next steps, getting a workers’ compensation attorney involved is the best next step. At Tabak Law, the consultation on your situation is completely free with no obligation.
It’s also important to know why a workers’ compensation claim can get denied. Let’s take a look at the top 10 reasons workers’ compensation claims get denied.

You didn’t notify your employer within the required timeframe

It’s crucial to report an injury to your employer right when it happens. If you do not, a number of factors come into play that make it easier for an insurance company to attempt to deny the claim. For example, the employer may not be able to properly investigate the accident due to the time lapse. In addition, the insurance company can try to claim that you were not actually hurt at work, with the reasoning being if you were, you would have reported it earlier.

The injury didn’t occur during typical work functions

If your injury didn’t actually occur at work, you likely aren’t in a position to receive benefits. But, there are grey areas to this part of the ruling. For example, if the injury occurs during a work event or even on your break, there are various factors that come into play that should at the very least be explored.

You didn’t visit an approved medical provider

Your employer and its insurance company have the right to provide an approved list of doctors to visit for treatment. The problem here is that this doctor may not have your best interest in mind regarding your claim. But, you also have the right to choose your own doctor as well. If there are competing opinions from the two sides, get an attorney involved right away, if you haven’t already.

workers comp claim typesYou have a pre-existing injury

Pre-existing injuries are an easy way for an insurance company to deny your claim. But the fact is, many work injuries do in fact make the condition worse than what was previously on record, meaning you could now be in a position where you can’t physically work, when you could previously. This, like the other scenarios, is a good example of a time when you should be getting an attorney involved.

You have no supporting medical records

If you didn’t receive any medical treatment in relation to your work injury, the insurance company may say that the injury didn’t exist when you say it happened. In addition, if you get laid off in between the time of the injury and when you file a claim, it could be stated that this was a cause and effect, and not related to an actual injury. Visiting a doctor right away is key if you think the injury could be actionable, but which doctor you choose is also very important.

Paperwork was not filed on time

In addition to reporting the injury to your employer and the other steps, you need to ensure that you actually file your paperwork on time if you are intending to make a workers’ compensation claim. If you miss the timeframe or deadline, you are again leaving your claim open to be questioned by the insurance company.

The injury occurred during actions outside of job duties

If your injury is a result of a fight, horseplay or other non work-related action, your claim is likely to be denied. Again, depending on the investigation of the incident, this could be mis-reported by the company, so a denial is only legitimate if this was actually the cause of the workplace injury.

You are unable to explain your injury

Within the grind of a workday, you may get injured and not realize it right away. This can make it tougher to pinpoint when and why the injury occurred, but it doesn’t mean that you are not eligible to make a claim.

Your employer disputes the claim

This encompasses many of the other reasons, but the fact is, your employer may dispute the claim that you submit. This is why it’s crucial to report the injury right away and get the process started. If there were witnesses, this should be part of the initial report as well.

A workers’ compensation lawyer wasn’t involved

No matter the situation, getting a workers’ compensation lawyer involved early on is crucial to getting approved. And if you’ve already been denied, a lawyer can also help you review your claim and set you up to get approved.
If you need advice on the next steps, please call Tabak Law at 844-432-0114 or fill out the simple form below. The advice is free and there is no obligation. If you do end up working with us, we collect 0 fees until you win, so it is completely risk free.

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