Five Reasons Workers’ Compensation Claims Are Denied

Workers’ compensation is meant to be easy and convenient for workers and employers alike. What happens when a claim goes wrong and an employee is left without the compensation they deserve? There are numerous reasons that a workers’ comp claim may be denied, and understanding these reasons can help you learn how to protect your claim.

If your workers’ compensation claim has been wrongfully denied, the team at Thiry & Caddell is here to help you. We’ve navigated many workers’ compensation cases throughout the Mobile area, and we know what it takes to protect workers’ rights. Call us at 251-336-3627 to set up a consultation right away.

Lack of Medical Evidence

One of the most common causes of claim denial is a lack of medical evidence. Sometimes, workers report their injuries but do not get them checked out by a physician. Many worry about angering their employer by seeking medical care. Unfortunately, without medical proof of your injury and its cause, there’s a good chance your claim will be turned down.

Workers’ comp may also deny your claim if you have a preexisting condition. This isn’t usually legal, since the existence of a preexisting condition doesn’t absolve your employer of their obligation to cover your accident-related expenses.

Failure to Report on Time

In the state of Alabama, employers are required to submit an injury report to the Workers’ Compensation Commission within 15 days of the injury or the onset of illness. Further documentation is required within 10 days of the first partial wage replacement payment. As an employee, you should report your injury immediately to your employer and fill out any requested documentation.

If you wait too long to report an injury, there’s less evidence available to support your claims. Additionally, your employer or their insurance provider may then suspect that your injury is not work-related and you are just trying to get it covered by workers’ compensation. Let your supervisor know about your injury right away and verify that they have properly documented it.

Use of Drugs or Alcohol

After you report an injury at work, you will be required to take a drug and alcohol screening. If any of the tests come back positive, your workers’ compensation claim will not be paid out. The Alabama legislature has specifically written this in to avoid paying out for accidents caused by drug or alcohol impairment.

Unfortunately, insurance companies do sometimes use this in bad faith. Perhaps you tested positive for prescribed medication or something that does not impact your concentration or ability to work safely—but the insurance company still rejects your claim. In that case, it is important to talk to a lawyer right away.

Unclear Cause of Injury

If there are any disputes over the cause of your injury, the workers’ comp insurance company may push back on paying out your claim. It is important to be clear and concise about what happened and avoid changing your story as you retell it, as any discrepancies may lead your employer to think that your story is made up. Claim denials may also happen if the type of injury you sustained is not consistent with your story of how it happened.

The issue of preexisting injuries comes up here again; if you do have a preexisting condition, it’s possible that your employer will try to claim that your condition is what led to your injury, not your work. An attorney can help you fight your claim denial.

Weak Supporting Evidence

While you don’t need eyewitnesses to get your workers’ comp claim paid, your company will look for supporting evidence to back up your claim. Surveillance footage can be useful, but it is a double-edged sword. In companies with widespread surveillance camera usage, there is automatic suspicion regarding injuries that happen in areas without cameras.

Struggling With a Workers’ Compensation Claim? Call Thiry & Caddell Today

If you’ve been injured at work and had your claim denied, it’s time to hold your employer accountable and assert your rights. Choose the team at Thiry & Caddell for your workers’ compensation claim. Call us at 251-336-3627 or send us a message online to schedule a consultation now.