Was Your Workers Comp Claim Denied? Key Reasons Why That May Happen

Law Blog

If you've never filed a workers comp claim before, you might wonder about how the process can be expected to go. You might assume that, since you were injured at work, it's a slam-dunk and you won't have anything to worry about. Unfortunately, that's not always the case. There are some situations where a workers compensation claim may be denied. In those cases, it's in your best interest to hire workers compensation attorney services to help you fight it. First, you have to understand why it was denied. Here are a few of the most common reasons why a workers compensation claim may be denied.

You Waited Too Long to Report

If you are injured at work and plan to file a workers compensation claim, you need to report the accident or injury immediately. Even if you aren't sure whether you'll need to file a claim, you should still report the accident right away. That way, it is documented as soon as it happens. If you wait to report it, any delay can be interpreted as either an indication that you aren't really hurt as much as you said you were or an attempt to file a claim for an injury that occurred elsewhere. In either case, your claim may be denied for the reporting delay.

You Didn't Get Medical Attention Right Away

If you're injured at work, you need to seek medical attention right away, especially if you think you might file a workers compensation claim. If you delay going to the doctor or don't go at all, you won't have the medical records to support your claim. Delaying is nearly as bad as not going at all because waiting to seek medical care can leave the insurance company questioning the legitimacy of your injuries.

Your Employer Questions Your Injury Being Work-Related

There are some fine lines about what can be considered work-related when it comes to injuries that qualify for workers compensation. For example, if you were on your lunch break or at a company-sponsored event off the clock, those types of things may not qualify as work-related for injury claims. If your employer has any reason to believe that you were injured during a period that doesn't qualify, the insurance company may deny your claim.

There Is Medical Evidence of Intoxication or Drug Use

If you sought medical attention right away, but there were indicators in the exam that you were either using illicit drugs or intoxicated at the time of the injury, your employer's insurance company may deny your claim. The justification is that were you not under the influence, the injury likely would not have happened anyway. The impairment in your judgment is reason enough to deny your claim.

You Were Laid Off or Fired Before You Filed

If you suffered the injury but were laid off or fired shortly after, filing the claim after the fact can sometimes be interpreted as an attempt at retribution against the company for the termination. You'd need to have sound proof of the accident or injury, including witnesses and justification of the reporting delay to avoid a denial in a case like this.

The good news is that you can seek an appeal if your worker's compensation claim is denied the first time you file. You'll want to work with a workers compensation attorney to file it, though. He or she will understand the law well enough to help you build a sound case for the reconsideration. If you want to minimize your risk of denial from the outset, you can retain an attorney before you even file the claim the first time. That may give you the support you need to ensure that everything is in order when you file.


26 November 2018