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Five common reasons for workers’ compensation claim denials

On Behalf of | Apr 11, 2022 | Workers' Compensation |

A workplace accident can quickly wreak havoc on your life, leaving you not only with physical pain and suffering, but also extensive financial losses. As a result, you might struggle to make ends meet as medical bills come due and your savings dry up. This can leave you feeling completely overwhelmed and stressed about what the future has in store for you.

The good news, though, is that you might be able to recover workers’ compensation benefits to help offset your losses. These benefits aren’t automatically granted, though, and oftentimes workers’ compensation claims are denied. Therefore, you should be aware of some of the most common reasons for claim denials so that you can best position yourself to avoid them. Let’s look at some of those reasons here:

  1. Your injury wasn’t suffered at work: In many workers’ compensation cases, the insurance company argues that the accident in question didn’t occur at work. That may seem pretty straightforward, but it can be a murky issue in some circumstances. This is especially true if you had a pre-existing injury that was exacerbated by a work activity or if you were injured at a work function that wasn’t at your normal place of employment. So, you’ll want to diligently prepare to ensure that your evidence shows how your injury is tied to your work duties.
  2. Your injury was suffered at work but only on account of horseplay: Even if it’s clear that an injury was suffered at work, an employer and its insurance company may try to deny the claim if they can argue that the injury was the result of some activity that was outside of the workers’ scope of employment. This is often seen in instances where an employee is joking around and gets hurt.
  3. Inadequate notification: When you’re injured at your place of work, you need to immediately notify your employer. If you fail to do so, then your delay could bar you from seeking benefits. You have to allow your employer the opportunity to investigate the accident, sure, but quickly informing your employer also shrinks the window of when your employer and its insurance company can claim you were injured. This reduces their ability to argue that you suffered your injury outside of work.
  4. The proper medical treatment wasn’t sought: To succeed on a workers’ compensation claim, you’re going to need medical evidence to support your position. If you never seek treatment for your injuries or you didn’t follow your doctor’s recommendations, then you put yourself at risk of having inadequate evidence to support your claim.
  5. Treatment was sought from an unapproved medical provider: In most cases, in order to recover benefits you’ll have to seek treatment from an approved medical provider. If you don’t see one of these providers and instead seek out your own treatment, then you could end up seeing your claim denied.

Anticipate and prepare to counter your employer’s defenses

By being cognizant of these common denial tactics, you can better prepare your claim and anticipate the defenses that you may see. To successfully counter those defenses, though, you’ll need to be armed with compelling evidence and strong legal arguments. That can be challenging to do if you have little experience in this arena and working with workers’ compensation laws. But that’s why law firms like ours are here to help. If you’d like to learn more about our firm and what we have to offer our clients, then please continue to read our website.

 

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