Why a Workers Compensation Claim May be Denied

Why a Workers Compensation Claim May be Denied

You should file a workers’ compensation claim if you incur a work-related injury. You’ll receive compensation to cover your medical bills, lost wages, and other damages. Unfortunately, the workers’ compensation system is complex, and your claim can be denied for various reasons. These may include;

1.Failing to hire a workers’ compensation attorney

The primary reason why workers’ compensation gets denied is due to a lack of legal guidance and knowledge. Without an attorney, you will likely make a mistake that your insurance will use as a ground to deny your claim. An attorney will ensure you have all the documents and get medical attention. Also, all your paperwork will be accurate and meet the deadlines. If you are seeking a skilled attorney, Click here to speak to a workers’ compensation attorney.

2.Drugs or alcohol were involved

Your employer/insurance company may request a drug or alcohol test if you suffer a work-related injury. If the results show that you were intoxicated or under the influence of alcohol at the time of injury, your workers’ compensation claim may be denied.

3.If your injury is connected to pre-existing conditions

If your employer/ insurance company proves that your injury was due to pre-existing condition, they may deny your claim. However, a pre-existing condition doesn’t mean you don’t deserve compensation. Your claim will succeed if you prove that the work injury aggravated the pre-existing condition.

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4.Failing to get medical treatment

If you incur a work injury, you should participate in medical treatment. If you refuse medical care, the insurance company can deny your claim. They might argue you didn’t get the injury at work and are not doing your best to get better and return to work.  

5.Your injury didn’t occur at work

Your employer might deny workers’ compensation injury if it didn’t occur at work. However, the injury doesn’t have to occur in your workplace to receive compensation. You would be eligible for compensation if you were performing your job when the injury occurred.

6.You intentionally injured yourself

Your workers’ compensation claim can be denied if you intentionally injured yourself to receive benefits. The law states that you are not entitled to benefits if the injury was intentional. Therefore, if the insurance company proves you acted intentionally, your claim will be denied.

7.Insufficient evidence

You must provide evidence to support your claim. You should gather documents such as medical reports, video footage, eyewitness testimonies, etc. If you have no or insufficient evidence, your employer may deny your claim.

8.Missed deadlines

The statute of limitation gives the deadline for filling workers’ compensation claims. Each state has different timelines for filing the claims. If you miss the deadlines, your compensation claim will be denied. 

Also, your claim may be denied if your paperwork is incomplete or inaccurate. Though compliance with deadlines and the accuracy of paperwork does not guarantee approval of the claim, it reduces delays and denial in your claim.

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Filing a workers’ compensation claim is the best legal action after incurring a work-related injury. If your claim is approved, you will receive a fair amount to cater for your loss or damages. However, most workers’ compensation claims are denied for the above reasons.   

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