5 Reasons Why Your Workers Comp Claim May Be Denied

Suffering an injury at work is a terrible thing, but a bad situation is made even worse when your workers’ compensation claim is denied. While you have the right to appeal a denial decision, it is helpful to know why the claim has been turned down. You may even need to consider hiring a workmans comp lawyer. These are some of the possible reasons for the denial.

1. A Non-Workplace Injury

For your claim to be covered, you must have suffered the injury while carrying out your job duties or while at work. A back sprain from lifting crates in the warehouse to a twisted ankle from tripping over a cord in the office are likely to be covered by workers comp. However, if you went out to lunch and tripped over the curb at the restaurant, you will probably not be eligible for coverage if you sustain any injuries.

2. Improper Notification

You are responsible for notifying your employer as soon as possible after an accident occurs, or at least within 30 days of the injury occurring. Your employer needs to document the incident and fill out a report, and waiting too long to register your injury may lead to insufficient evidence. The insurance company will try to argue that your duties did not impact your health and that the condition was pre-existing or occurred off the clock. Protect your claim by telling your supervisor right away if you have been hurt on the job.

3. Substance Abuse

If an injury has occurred, your employer can request that you be given a drug or alcohol test. If they find these substances in your system, it is likely that a claim will be denied. You may not have the eligibility to file a claim at all.

4. Out-of-Network Provider

Your employer will have a list of approved physicians and treatment centers, but failing to use one for your medical care can result in denial of a claim. It is acceptable for you to seek a second opinion, particularly if the physician tries to minimize the severity of your injuries. Injuries that aren’t deemed severe often result in lower benefit payouts.

5. Lack of Medical Care

If you suffered an injury but don’t receive medical care for it, your claim is likely to be denied. Without medical records documenting your injury, the insurance company and your employer will assume you are faking the injury for the benefits.

Protect your ability to receive workers comp benefits if you are injured at work. Always report the injury immediately, and follow your company`s policy for seeking treatment.