Workers’ compensation is not as cut and dried as everyone assumes. Despite state laws requiring all employers to compensate workers for work-related injuries, denied workers’ compensation claims are a reality.
Employers and insurance companies thoroughly investigate all compensation claims. This means that any irregularities in your claim will result in a denial. So, how does workers’ compensation work? And, what are some workers’ compensation claim denial reasons commonly cited by insurance?
Delayed Report of Injuries
In most states, injuries received at work must be reported within 30 days. The formal application must be submitted to your employer including the notes from your physician. Reporting late is one reason that an employer may use to deny your claim or offer lower compensation.
Lack of Witnesses
The burden of proof lies with the injured claimant. Witnesses who can confirm that the injury occurred as reported will fortify your compensation claim. However, if your employer or the insurance company can only rely on your word and your doctor’s report, your claim could easily get denied.
Alcohol or Drug Use at the Time of the Injury
Blood tests will usually be performed after a worker is hospitalized with an injury. If the test results indicate that you were under the influence of a mind-altering substance, your claim will be automatically denied.
The Injury Did Not Occur at Work
Insurers will argue that an injury is not work-related when it is an activity not sanctioned by our employer or if you were running private errands. Even though you might have been at your work premises, you still have to prove that you were doing your designated work.
Examples of such injuries would be those occurring during your commute or resulting from pranks and capers with colleagues.
Lack of Medical Evidence
Medical reports, doctor’s notes, and test results are crucial to the investigation process of a compensation claim. The insurer will look through every detail of your medical records to make sure there are no discrepancies. Failure to produce medical records will lead to a compensation claim denial.
Pre-Existing Conditions
Pre-existing conditions are health conditions that could have caused or worsened the injury. For example, an employer may cite pre-existing conditions if an employer was already being treated for chronic back pain when they report a back injury at work.
Though it’s still possible to contest the pre-existing condition citation and prove otherwise, the compensation will usually be lower.
In many cases, a denied compensation claim can either be appealed or settled during an administrative hearing. During both processes, it is important to have a workers’ comp attorney to advise on your options and represent your interests. They also know all the legal intricacies and can help you stay ahead in the claiming process.
If you or a loved one have suffered an injury at work and are looking for a workers’ comp lawyer in Gainesville, GA, contact Stewart Melvin & Frost for a consultation. Our worker’s compensation attorneys are some of the most respected in the state and can advise you according to your needs and current laws. Also learn why workers’ compensation insurance is good for business
