Workers’ compensation laws are meant to help employees and employers deal with workplace injuries. It’s a “no-fault” system where injured workers receive compensation for lost wages and medical expenses after a workplace accident, and employers get protection from costly lawsuits. But this win-win situation does not always play out fairly in practice, such as when the employer’s insurance carrier denies a legitimate claim. 

The workers’ compensation system is complex, and your claim could be turned down for a number of reasons. But why? Let’s take a look at the top 5 reasons your worker’s compensation claim may have been denied:

You didn’t notify your employer in a timely manner

It’s crucial to report an injury to your employer right when it happens. If you don’t, 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 because if you were, you would have reported it sooner.

Medical records do not support your injury claim

To build a successful workers’ compensation claim, you need to provide supporting medical evidence. Filing a workers’ compensation claim without the medical proof to back it up will give the insurance company a reason to deny your claim. That’s why one of the first things to do following a workplace injury should be to see a doctor and get your injury documented and treated. Make sure to document ALL of your injuries and symptoms, even if they seem insignificant or unrelated at the time.

You have a pre-existing injury or condition

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 underlying condition worse, meaning you could now be in a position where you can’t physically work, when you could previously.

The injury occurred outside of normal job duties

To be eligible for workers’ compensation benefits, you must be injured while in the course and scope of the job you were hired to do. If your injury is a result of a fight, horseplay or other non work-related action, your claim is likely to be denied. 

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 any witnesses, this should be part of the initial report as well.

If the insurance company denies your claim, you can appeal the decision. The appeal process is complex and challenging, but our experienced team at Scartelli Olszewski can help. For a free consultation, contact us today. 

 

Source: https://www.dol.gov/general/topic/workcomp

https://www.thehartford.com/workers-compensation/questions-answered

https://www.dir.ca.gov/dwc/MyClaimWasDenied.htm

https://www.dir.ca.gov/dwc/WCFaqIW.html#76