Why Was My Workers’ Comp Claim Denied?
When you get injured on the job, workers’ comp is there to make sure you can still collect a paycheck while you recover. But why was your workers’ compensation claim denied? In this video we’ll look over the 10 reasons why your workers’ comp claim might have been denied.
1. There wasn’t a workplace injury. In order to qualify for workers’ comp, the injury must have occurred during the “course and scope” of your employment. AND, the injury must arise out of the employment. If the injury occurred outside of work, your workers’ comp claim is likely to be denied.
2. Your injury isn’t covered. Workers’ comp is a type of insurance policy, and just like with your home or auto insurance not everything is covered. Mental health issues are rarely covered by workers’ comp. So even though you might have a stressful job that causes you to seek treatment, those costs wouldn’t be covered.
3. You waited too long to report the injury. You only have 30 days to file a workers’ comp claim after the injury. The insurance company might try to argue that you aren’t seriously injured if you wait to report the injury and file a claim. And if you are fired or laid off before reporting the injury, it could look like you are just trying to get revenge. The best thing to do is report the injury right away.
4. There are no witnesses. While this should not be an automatic dealbreaker, it’s easier for your workers’ comp claim to be denied if nobody else saw it (or there is no security footage) and it’s just your word on what happened.
5. You changed your story. Keeping the facts and details of what happened consistent is critical, especially if there are no other witnesses or surveillance footage. Differences between the report you file at work, and the medical report, could be considered by the insurance company as a red flag.
6. You have a pre-existing condition. Many workers’ compensation claims are denied because of pre-existing conditions. But the truth is that pre-existing conditions do not prevent you from filing a workers’ comp claim. Generally speaking, if you are in an accident at work and that accident is greater than 50% of the cause of the injury you sustain, you should be able to secure workers’ compensation benefits.
7. Lack of cooperation. If you don’t cooperate with the insurance company, they might deny your claim. This could happen if you refuse to provide a recorded statement describing the accident and the injury, or if you do not sign a medical release allowing them to collect your medical records directly from your doctor. However, it is well within your rights to refuse to give a recorded statement or sign a medical release. If that happens and your claim is denied, you should contact a workers’ comp attorney immediately.
8. The injury is intentional. It should go without saying, but if you injure yourself intentionally while on the job, your workers’ comp claim will be denied. Your benefits can also be reduced, or denied entirely, if you ignore safety regulations.
9. Illegal drugs are detected in your system. Your employer can request a drug test at any time, and will often request one after an accident. If illegal drugs are found in your system, your claim will likely be denied.
10. You were the aggressor in a fight. If you started a fight, your claim will be denied. And even if you didn’t start the fight, the fight has to be connected to work in order to be covered by workers’ compensation.
If you believe that your workers’ comp claim was unfairly denied, you need a good workers’ comp attorney at your side. After all, the insurance company is sure to have a team of lawyers working the case for them.
Here at the Law Office of Brian D. Tadros, we practice ONLY workers’ comp law.
Call Brian Tadros today for a free consultation.