Decades Of Experience In Workers’ Compensation And Social Security Disability

Avoid these reasons for workers’ compensation claim denial

On Behalf of | Dec 19, 2023 | Workers' Compensation

In the blink of an eye, a workplace accident can leave you with serious injuries, making it temporarily impossible to work and earn a wage. This lost income, coupled with medical expenses you’ll have to incur, can put you on rocky financial footing, uncertain of what the future has in store for you. That can be stressful, for sue, but you might be able to secure financial relief through the workers’ compensations system.

Your workers’ compensation claim won’t be automatically granted, though, meaning that you’ll have to be prepared to advocate for the outcome that you want. One way to ready yourself for the process ahead is to know common reasons why worker’s compensation claims are denied, that way you can work to avoid them.

Insurance companies are adept at finding ways to deny claims, including workers’ compensation claims. Here are some of the reasons why these claims are denied:

  • Failure to report in a timely manner: When you’re injured on the job, you typically have 30 days to report your injuries to your employer. If you don’t do so, then you might be barred from seeking workers’ compensation benefits.
  • Lack of evidence: You might think that saying you were injured on the job is sufficient to recover the financial support that you need from the workers’ compensation system, but that may not be the case. In most instances, claimants need some sort of corroborating evidence, whether from witness accounts or video of the incident. Be diligent in assessing what evidence you can present to support your claim.
  • Pre-existing condition: The insurance company is going to try to scour your medical records to see if they can argue that your claimed injuries were in existence prior to the accident in question. If they’re successful in making that argument, then your claim will probably be denied. So, be aware of what existing medical conditions might be brought to light and how you can deflect the insurance company’s arguments about their lack of link to your workplace accident.
  • The claimed injuries were suffered outside of work: Similarly, the insurance company could discover information that indicates that your injuries were caused by some event outside of work rather than your workplace accident. You’ll therefore need to find a way to directly link your injuries to the workplace accident.
  • The injuries were a result of horseplay: Workers’ compensation will only cover your injuries if you were performing your job duties at the time you were hurt. So, if you were messing around with co-workers and were hurt as a result, then the insurance company is going to say that it shouldn’t be forced to pay for injuries that you brought on yourself.
  • Out-of-network care: Workers’ compensation policies tend to have strict terms regarding where medical care can be received. If you seek out treatment from someone who isn’t covered by the policy, then workers’ compensation isn’t going to help you pay for your medical expenses. So, make sure you understand the terms of the policy so that you can seek care from a covered provider.

Know how to carefully and aggressively navigate your workers’ compensation claim

You need workers’ compensation benefits to offset your losses. Therefore, there’s a lot on the line as you prepare to navigate the process. With so many pitfalls along the way, you owe it to yourself to educate yourself on the process and what you can do to strengthen your case. Hopefully then you’ll be able to recover the financial resources you need to fully recover from your injuries and get back to work.