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Common Reasons for Workers’ Comp Claim Denials

Workplace accidents can not only lead to fatal injuries and loss of life but can also have massive financial ramifications for any business. Unfortunately, job site accidents are bound to happen no matter the safety measures you put in place. To reduce financial liability in the event of workplace accidents, business owners offer their employees workers’ compensation insurance to cover expenses often associated with workplace injuries and illnesses. This coverage also covers an employee’s lost income if they have severe injuries, making them unable to continue working for a certain period.
While workers’ compensation insurance is usually awarded to employees who sustain injuries or illnesses at the workplace, not all claims are approved. Many factors are considered before your workers’ compensation claim is approved. These policies don’t always cover all illnesses and injuries, even if they happen at the workplace. Due to the complex nature of workers’ compensation claims, you should consider working with an experienced and dedicated attorney like HHFR attorneys, who can protect your rights and fight for you to ensure you get the compensation you deserve for your injuries. Here are a few top reasons why workers’ compensation claims may be denied to help you avoid these situations:
1. Your Application Was Late
One of the most common reasons your workers’ compensation claim may be denied is if you filed your claim late. There are specific deadlines and time limits within which you should file your compensation claim. Insurers usually have strict deadlines for filing compensation claims to help weed out fraudulent applicants. Most applicants miss these deadlines because of late filing of paperwork and clerical errors. Not informing your employer about your injuries immediately can also increase the chance of missing the application deadlines.
It’s critically important that you have all the necessary paperwork and submit your claim application within the required time limit to reduce your risk of denial. Filing your claim on time is crucial, even if your injuries or illness develop gradually over time. If you miss the deadline, make sure you have a solid reason for the delay. Otherwise, your insurer will have a reason to deny your claim.
2. You Contributed to Your Injuries
Workers’ compensation claims are meant to cover only unintentional workplace injuries. Hence, your claim will likely be denied if the workplace accident resulted from horseplay, practical jokes, or roughhousing. That’s because your insurer considers you intentionally failed to observe safety protocols, contributing to your injuries.
Your insurer may also deny your claim if you were intoxicated during the accident. If an employer thinks alcohol and drugs contributed to a workplace accident, they may require the injured employee to undergo a drug test. Besides having your claim denied, your employer may even terminate your contract for breaking the company’s policies on drug and alcohol use in the workplace. In some cases, you may need to convince the appeals officer that the drugs or alcohol didn’t contribute to the accident.
3. Not Seeking Immediate Medical Attention
While you may be entitled to a workers’ compensation claim after sustaining injuries in the workplace, not seeing a doctor immediately after you’re injured can lead to claim denial. You need medical records to prove you sustained injuries in the workplace to qualify for workers’ compensation. Without the medical records, your insurer may claim you faked the injuries, or your injuries happened outside work. Make sure you seek immediate medical attention after sustaining injuries at the workplace. This way, you’ll have all the necessary medical records to support your claim.
Additionally, check to ensure you visit an in-network medical provider within the insurance company’s network. This is crucial since some workers’ compensation policies may require you to visit a specific doctor after getting hurt at the workplace.
Endnote
Many things can lead to workers’ compensation denials, and several issues can arise during the case, making it difficult to get the compensation you deserve. However, partnering with the right attorney can help make the process easier and ensure you get your compensation faster. If your claim is denied, your attorney will help prepare the paperwork and gather the necessary evidence to appeal your case and increase your chances of success.

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