In only takes a fraction of a second for a workplace accident to result in significant injuries. And when that happens, you can be left unable to work, which can leave you without the financial resources needed to offset your lost income and your medical expenses. This is where a workers’ compensation claim may prove beneficial, as a successful claim can lead to ongoing payments that can stabilize you in your time of need until you can return to work.
But your employer’s insurance company isn’t going to willingly hand out these payments if they can avoid doing so. Therefore, they’re going to scrutinize nearly every aspect of your case to see if they can find a reason to deny it. Before filing your claim, then, you should have a firm understanding of the weaknesses in your case. That way you can try to support your claim more fully before filing it, thereby reducing the risk that it’ll be denied. So, let’s look at some reasons for workers’ compensation claim denials and what you can do to effectively address them.
Anticipate these reasons for workers’ compensation claim denials
There are many denial justifications that you’ll need to be prepared to address. These include:
- Your injuries were suffered outside of work: Your employer’s insurance company is only going to pay you benefits if you can demonstrate that your injuries were caused by something that happened at work. If they can demonstrate that your injury was caused by activity outside of work, then they’ll deny your claim. So, be sure to clearly document how and when your injuries were suffered so that you can head off this attack on your claim.
- You have inadequate medical evidence: Although you might hope that the insurance company will take you at your word when it comes to the nature and severity of your injuries, that’s not going to happen. Instead, you’re going to need medical evidence to support your claim. If you don’t, then the insurance company is going to shrug off your claim and deny it. So, be sure to see your doctor for treatment of your injuries and so that you can obtain a prognosis that you can use to support your claim.
- You suffer from a pre-existing condition: The insurance company is going to look backward in time to see if they can tie your claimed injuries to something that already existed in your medical history before the accident in question. But even if your pre-existing condition is wrapped up in your claim, you can talk to your doctor about it to ensure you’re building a record that shows how the workplace accident in question exacerbated that condition.
- You engaged in horseplay at the time your injuries were suffered: If you were messing around at work and got injured, then the insurance company will argue that your injuries weren’t suffered in the course of employment since you weren’t performing your job duties at the time. Again, be sure to thoroughly document the event and speak to witnesses who can give a realistic portrayal of what the event looked like.
Don’t miss out on the workers’ compensation benefits you deserve
The outcome of your workers’ compensation case can make all the difference in your recovery. But you only get one shot at proving your case, including the ability to appeal an initial claim denial. So, be sure to build the strongest case possible on the front end so that you can rest assured that you’ve done everything possible to recover the benefits you deserve. An attorney who is skilled in this area of the law may be able to assist you in securing the outcome that you want.