Suffering a workplace injury can be hard enough without having to deal with getting your workers’ compensation claim denied. Unfortunately, denials happen frequently for a variety of reasons. Understanding them can empower employees to avoid these pitfalls proactively.
This article covers the common causes a workers’ comp claim gets denied, underscoring the importance of hiring skilled workers’ compensation lawyers to guide you through the process.
Failed To Report the Injury on Time
Most states require you to notify your employer within 30 days of suffering a work-related injury. Failing to report it on time gives grounds for denial. As soon as you get hurt on the job, alert your supervisor right away and file the proper paperwork to avoid getting denied.
Missed the Deadline for Claim Filing
While injury reporting requirements vary by state, workers’ compensation claims often need to be officially filed within six months to one year of the date of injury. The filing deadline is one of the most common reasons insurers refuse benefits. Consult your state’s workers’ compensation board to learn the exact requirements so you don’t accidentally file late.
Submitted Paperwork With Errors
Incorrect or incomplete documents can also hinder claim approval. The complexity of workers’ compensation forms makes errors common. However, meticulous attention to detail when filling out these papers can prevent unnecessary delays or denials.
Reported Illness or Injury Not Correlated to Work
For a claim to be valid, the impairment must be directly related to one’s job duties or occurred in the workplace. Denials usually happen when there is insufficient evidence to link the injury to the work environment. Providing detailed accounts of how it transpired can bolster your claim.
Provided Explanation With Inconsistencies
Discrepancies between what you tell your employer and your doctor and what you include in your workers’ compensation claim could signal potential fraud to insurance adjusters. Stick to the truthful facts and be consistent in all your reports to avoid denial.
Claimed Compensation for Preexisting Conditions
Workers’ comp can cover exacerbations of preexisting illnesses and injuries from repetitive motions at work. For instance, if job activities worsen existing back pain, you could qualify for benefits. However, insurers may deny claims, arguing the issues predated workplace incidents. Demonstrating that your condition worsened due to work activities is crucial.
Received Out-of-Network Medical Care
To maintain control, workers’ compensation insurers often restrict which doctors you can see for treatment. Many states mandate you use a physician from your employer’s approved provider. Seeing an out-of-network doctor without authorization could prompt care denial and claim challenges. To ensure coverage, always verify network status before treatment and clarify state network requirements for workplace injury claims.
Continued Working While Injured or Sick
To qualify for workers’ compensation wage benefits, you typically need to miss a minimum number of days of work due to your injury. Each state sets its own required waiting period, usually 3 to 7 days. If your impairment never caused you to miss time from work, your claim may be denied.
Failed an Alcohol or Drug Test
Many employers test their employees for drugs or alcohol after a workplace injury. If the results are positive, it may result in an automatic denial of your claim. Even marijuana use in states or cities where it is legalized can still result in workers’ comp denial federally. Abstaining from substance use is critical, especially in occupations prone to accidents and injuries.
Ignored Workplace Safety Protocols
Workers’ comp is a no-fault system, which means you are eligible for benefits even if the accident occurred due to a genuine error on your part. However, your claim may be rejected if the insurer can show your injury resulted from negligence, violation of rules, or disregard for safety measures.
Examples include injuries while fooling around, misusing equipment, or texting while driving a forklift, as these incidents are likely to be deemed negligent by the insurance company.
Encountered Employer Dispute
Sometimes, a manager might contest a claim if they believe the injury was not work-related or if they have evidence contradicting the employee’s account. This situation often requires intricate navigation of the legal process, where the expertise of workers’ compensation lawyers becomes invaluable.
Get Excellent Legal Support
If you’re facing challenges with a workers’ comp claim or are concerned about potential pitfalls, seek the expertise of professional workers’ compensation lawyers. Their guidance can be the difference between a denied claim and the settlement you rightly deserve. Remember, acting promptly and getting knowledgeable support significantly increases your chances of a successful outcome.
