Common Reasons Why Workers’ Compensation Claims Are Denied

The workers’ compensation system is supposed to be easy and straightforward, so you may be shocked and disappointed when your claim gets denied. Too many companies and workers’ compensation insurance providers make employees jump through hoops to get the benefits they are entitled to.

Learn more about why your claim might have been denied, and for more personalized advice, call Thiry & Associates at 251-351-3371.

No One Saw Your Accident

Eyewitness accounts always help a workers’ compensation claim, so you may have a bit of an uphill battle if there weren’t any coworkers around when you got injured. Workers’ compensation insurance companies like to talk to eyewitnesses because this eliminates the possibility that an injury occurred away from work or was entirely falsified. If there were no witnesses to your injury, you may have to provide additional evidence of your accident.

You Waited Too Long to Report Your Injury

The longer you wait to report an injury, the more suspicious it looks to insurance providers. If you wait too long, you could even miss the legal window to report your accident, which essentially means giving up your right to workers’ compensation. Report any accidents to your supervisor right away to avoid this issue.

They Think You Lied About the Injury

If there are discrepancies about your injury or accident, they may believe that you falsified the accident. This is relatively rare, but workers’ compensation companies often consider it a big enough problem that they challenge a lot of reports. Basically, they want to avoid paying out for an injury that someone made up to get some time away from work.

They Believe the Injury Happened Outside of Work

Along the same lines, workers’ compensation insurance will often deny claims if they think an injury occurred outside of work. This does happen sometimes. If someone gets injured but does not have the money to get treatment for it, they may pretend it happened at work to get their treatment covered. If your insurance company suspects this, they may request additional medical records or require more extensive diagnostic tests to figure out when the injury started.

You Didn’t Cooperate with the Insurance Company

To get insurance to pay for your injuries and your lost wages, you do need to cooperate with their requests. That means attending a doctor they allow you to see, attending all scheduled appointments, and following all recommended care instructions. If you frequently miss appointments, ignore the restrictions put on you by your doctor, or do not take your medications, your insurance company may believe that you are drawing your injury out to take advantage of benefits.

Your Story Changed

Maybe you first told your supervisor your accident happened when you slipped and fell on a wet floor. But later, on official documentation, you say you got hurt by an item that fell off of a shelf. Small differences in a story are inevitable and are unlikely to affect your workers’ compensation claim, but if you completely change your story, expect some pushback.

Your Injury is Due to a Preexisting Condition

This is another common excuse used by workers’ compensation insurance companies. Perhaps you have a bad back, so they think they don’t have to pay out anything for a back injury sustained at work. However, a preexisting injury doesn’t give your workplace free rein to deny claims as they wish. Even if you do have a preexisting condition, you may still be entitled to compensation for an injury sustained at work.

The Claim Occurred After Termination

This is another reason to report workplace injuries as soon as they occur, rather than waiting until you have enough time to sit down with a supervisor. If an employee is terminated and then files a workers’ compensation claim, the insurance company is likely going to assume that the employee is trying to get revenge. Even if the claim is completely valid, you can expect the insurance company to take their time validating it and paying it out. You can avoid this issue by reporting injuries immediately.

Get the Help You Deserve with Thiry & Associates

When you get injured at work, you should be able to get access to your benefits immediately. However, if you are having issues with your employer or insurance provider, you may need to push a little harder to get the benefits you are entitled to. We can help. We know how you rely on workers’ compensation after a workplace injury, and we routinely go up against companies that take advantage of hardworking employees. To learn more about your legal options, set up a consultation now by calling us at 251-351-3371 or reaching out to us online.