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Why would a workers’ compensation claim be denied?

On Behalf of | Oct 8, 2021 | Workers' Compensation

When you suffer a work-related injury, you deserve to get the medical care and support that you need. If you have to miss work, you may be entitled to a portion of your normal wages, too. Medical support, replacement for lost wages and other benefits are all part of workers’ compensation.

Normally, someone who gets hurt on the job reports the injury and then receives care. Their employer helps submit the claim, and, in a best-case scenario, they get that claim approved without question. This is, ideally, how a workers’ compensation claim will work.

Unfortunately, there are times when claims can be denied.

Why would your workers’ compensation claim be denied after an accident?

Workers’ compensation claims are normally denied when:

  • It is believed that your injury didn’t happen at work or as a result of work
  • You didn’t inform your employer of your injuries soon enough
  • You did not get treatment from an approved medical professional (excluding the initial visit)
  • You didn’t seek medical care
  • You were under the influence of drugs or alcohol when the accident occurred
  • You didn’t file the appropriate paperwork soon enough
  • You had a pre-existing condition that caused the injury
  • You intentionally hurt yourself

In some cases, your employer may dispute your claim. If that happens, then the insurance company may deny your claim, too.

What can you do if your workers’ compensation claim is denied?

If your workers’ compensation claim is denied, you have the option of appealing that decision. When you appeal, you will want to take steps to show how your injury is linked to your work. For example, the denial might have suggested that your auto accident wasn’t linked to your work or that you weren’t on duty at the time. If you can show that you were clocked in and performing a task for your employer, then the claim could be approved.

With any appeal, it’s smart to get a better understanding of the law before submitting it. That way, you can improve your chances of having the appeal go through, so you can get the benefits that you need.