Top Six Reasons Workers’ Compensation Claims Get Denied

Insurance companies deny a substantial amount of insurance and social security claims, including workers’ compensation. Sometimes, the reason for denying the workers’ compensation claims is valid, and sometimes it’s not.

Insurance companies think that you will take their word and move on. But, as an alert, responsible citizen and a customer, you should be aware of your rights. You should know whether the claim was rejected on legitimate grounds or not. This blog will discuss six common legitimate reasons workers’ compensation claims are denied.

The place of injury is not valid.

You are eligible for workers’ compensation benefits only if you suffer an injury at the workplace. Besides, the injury must have occurred while you were performing your job duties. For instance, suppose you work at a construction site and suffer an injury while constructing a wall, then you will likely receive your workers’ compensation benefits.

However, you cannot receive benefits if you were injured while commuting to the construction site. You will likely need witnesses or CCTV footage to prove that the injury occurred during work activities and work hours.

You did not notify your employer.

It would be best if you informed your employer of the injury as soon as possible. If you delay notifying your employer, they might not be able to successfully carry out an investigation. Most insurance companies deny claims stating that you were not actually hurt at work as there is no conclusive report to back it up. Thus, report the injury as soon as possible to your employer to not miss out on the benefits you rightly deserve.

You did not receive medical treatment.

If your injury is entitled to compensation, you will need to have the respective medical records. The records should be from a medical professional stating that you were injured at the workplace. It should also mention details such as the date, time, place, what led to the injury, the type of injury, and the first aid treatment administered. If you don’t have the supporting medical documents to prove your injury, the insurance company can deny your claim. So, make sure to have all the necessary documents at hand while filing for compensation.

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You failed to file your claim on time.

There are time limits to filing claims. If you do not file your papers on time, the insurance company may deny your compensation. And it is understandable. You can’t file for a workers’ compensation claim years or even months after an injury and expect to receive compensation. You should hire an experienced attorney to handle your paperwork and file your papers on time. Don’t miss out on compensation due to silly reasons, such as being late in filing.

You have a pre-existing condition.

If you suffer from a pre-existing medical condition, and the injury didn’t aggravate the condition, your compensation claim will be rejected. The insurance company has a valid reason to reject your claim as the injury didn’t occur from any work activity. However, there is a lot of gray areas in such situations. You need to consult an experienced lawyer to know whether you will be entitled to receive the benefits or not because of too many complexities involved.

Your employer denies the claim.

In some cases, it is not the insurance company but your employer who will hinder your claim. They might argue that the claim filed is invalid, with false and incomplete details. They might even argue that the injury didn’t happen at work or that you weren’t even present at work on the mentioned date. This might be because they are scared that the cost of workers’ compensation coverage will increase. Hence, they will try their best to contest your claim and show that it is false.

The situation can get worse and in favor of the employer if there are no witnesses or CCTV/video footage or any proof that confirms the injury during work. It would be best to inform a co-worker immediately about the injury to strengthen your claim in such cases.

If the insurance company is denying your claim, you shouldn’t walk right away. Instead, ask why your claim was rejected, request details, and see if the reason given is valid or not. If you think that the reason was invalid, you can take legal action against the insurance company. You can then ask for your rightful compensation and claim additional expenses for the legal proceedings and the mental trauma that occurred in the first place.

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