5 Common Reasons That Workers’ Comp Benefits Are Denied

On Behalf of | Feb 15, 2023 | Workers' Compensation |

If you’ve been hurt on the job, you may be able to file a claim for workers’ compensation benefits to help you get back on your feet. However, as with any insurance claim, the insurance company or even your employer may look for a reason to deny your claim.

In fact, there are several common pitfalls that affect many employees when they’re seeking to get their workers’ compensation claim approved. Let’s take a look at five common problems that can lead to the denial of workers’ comp benefits.

1. Pre-existing conditions

If the insurance company finds that you have experienced an injury in the past that seems related to your work injury claim, it can be a huge barrier to your case. That doesn’t mean you can’t file a successful workers’ compensation claim if you have a pre-existing injury or condition, however. You’ll just need to make sure you have all the evidence you need to show that you have a new injury.

2. Employer dispute

It’s often in the employer’s best interest to dispute the details of your claim. After all, if your company paid out every workers’ comp claim, its insurance rates would skyrocket!

For example, your employer may claim your injury was not work related or that you weren’t at work at the time of the injury. This is why it’s so important to gather as much evidence as you can to support your claim. Having eyewitnesses or other ways to corroborate your workplace injury is essential.

3. Lack of medical treatment

Don’t avoid or delay seeing the doctor after a workplace illness or injury. If you’re injured at work, you’ll need to provide medical records to substantiate your injury. Without proper documentation of your condition, you’ll face an uphill battle for your claim.

Also, pay close attention to any restrictions in your employer’s workers’ compensation policy that may require you to use in-network providers for treatment related to your claim. Be sure to see an in-network doctor right away.

4. Missed deadlines

Too often, otherwise valid workers’ compensation claims are denied because the claimant misses an important deadline. If you are injured at work, it is important to report the illness or injury to your employer immediately and to file your workers’ compensation claim with the appropriate state agency. Timely reporting and claim filing are essential to a successful workers’ comp claim.

5. Misconduct

If the insurance company can demonstrate that you were injured because you engaged in horseplay or roughhousing at work, your claim is likely to be denied. The same is true if your employers shows that you were under the influence of drugs or alcohol at the time of your injury.

What should you do if you receive a workers’ compensation denial?

These are just a few of the common reasons that workers’ compensation claims may be denied. If you’ve been injured at work and are considering whether you should file a workers’ compensation claim and may be subject to one of the pitfalls above, seek legal advice.

And if you’ve already received a denial of your application for workers’ compensation benefits, don’t give up hope just yet! You may be able to appeal the determination as long as you meet the required time frame. Contact Hunter & Everage today, and let us help you navigate this complicated process.

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