When someone gets hurt on the job, they typically are prevented from personally suing their employer. Instead, they go through the workers’ compensation system, managed by their state. Workers’ compensation can provide payments to cover some of the lost wages stemming from an injury that happens on the job, as well as coverage for medical payments.
From the employer’s perspective, workers’ compensation is beneficial because it shields them from liability.
Not every workers’ compensation claim is approved, though, and they are carefully investigated.
The following are six of the common reasons a workers’ comp claim might be denied.
1. Not making a deadline
One reason you can get denied is if you don’t meet all the deadlines. To receive workers’ compensation benefits, you have to report your injury or illness right away to your employer. Then, you have to file a claim with the state agency. In some states, the insurance company or your employer handles this part, but to do so, you still have to notify them of the injury.
States have varying time limits to report injuries and file claims. If you don’t make the deadline, there’s a significant likelihood your claim is going to be denied.
In some states, you might not be penalised if you don’t make the reporting deadline, as long as your boss is aware of the situation, but your claim would still have to be filed in time.
If you are ever hurt at work, it’s extremely important to report it immediately. While most states have a period of seven days within which you can report an injury, it’s much better to do it sooner.
2. There’s a dispute about whether the injury happened at work
Another common reason for workers’ comp claims denials is if there’s a dispute about where the injury actually occurred and the situation surrounding it.
Your employer could claim you weren’t working when you were injured. Even if you were at work, they might say you were off the clock.
Your employer could also say that you were involved in misconduct when the injury occurred or that your condition isn’t the result of an accident or exposure at work. Anytime there’s a dispute, you need to get evidence to support the claim.
You might have to collect witness accounts or medical evidence.
Maybe the doctor who’s treating you already says your condition is related to your work, but the insurance company doesn’t agree, in which case you might need an independent exam from another doctor.
3. You filed a claim after you were let go
There are employees who were hurt at work, but they might wait to file a claim. Then, by the time they file the claim, they’ve been laid off or fired.
An insurer isn’t likely to trust a claim that’s filed after you’re fired. There’s the assumption that the claim is one of revenge, regardless of the reality.
This is one more reason that you shouldn’t wait to file a claim if you are legitimately hurt at work. If you’re laid off before you file a claim, it’s going to be challenging to convince the insurance company and a workers’ compensation judge that your injury really is from work.
4. There’s a discrepancy between your report and your medical records
Insurers will deny claims in many cases if they spot a discrepancy between your accident report and your medical records. For example, maybe you tell your supervisor one thing about the accident, but you tell your doctor something else. It might not even be on purpose, and it could be because you honestly have a hard time remembering the details, but it can still hurt your claim.
You need to be very consistent when you’re recounting the accident.
5. You were under the influence
If you were under the influence of drugs or alcohol when you were in a workplace accident, you can’t make a claim. Your employer can require you to be tested for drugs or alcohol when you go to see a medical provider for a workplace injury. If there are substances in your system, your claim is very likely going to be denied.
6. You didn’t get medical treatment
Finally, if you think you’ve got hurt at work to the point that you’re entitled to a workers’ compensation claim, you need to have the medical records to back it up. If you don’t see a doctor or get medical treatment, and then you try to file a claim later, the insurance company can deny it.
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