What Are the Top 3 Reasons Workers Comp Claims are Denied?

top three reasons workers comp claims are denied
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Workers’ comp is an important tool for workers when they sustain injuries. One of the big problems, however, is that sometimes, a person making a workers comp claim may find it be denied for any number of reasons. It can be even more difficult if you are not aware of your rights, which may lead to you very well giving up. In order to avoid having this happen, we will look at the top three reasons a workers comp claim is denied, and how one can work to get around these denials.

The Three Most Common Reasons Workers Comp Claims are Denied

Some reasons for denials are going to be more legitimate than others, but at the same time, any reason for denying a workers comp claim can be used maliciously. One of the big reasons why this happens is because there is a financial interest in businesses not allowing people to receive workers comp. This is because, while they themselves are not the ones who are responsible for paying employees on workers comp, they still have to pay for that insurance. And the fewer people who receive workers comp, the better the rates they pay for this are. Not only that, but if they have an above-average rate of people filing workers comp claims, it may make them appear to be a dangerous place to work, leading to them suffering consequences as a result. No matter how legitimate the reason to deny it may seem, do not take them on their word. Push back on the matter, especially with a lawyer who has more experience identifying legitimate workplace injury cases. The last thing you want to be is struggling with a work-related injury while receiving none of the compensation that you are entitled to.

Your injury did not happen at work

In the event that you did not sustain your injury at your place of work, then you are not likely going to have that injury covered by workers’ compensation. However, that is not necessarily the end of it all. As we mentioned above, sometimes an employer will simply fudge details, or even lie, about the nature of your injury, such that they ultimately cheat you out of the coverage that you are entitled to. There are two approaches that need to be taken to determine whether the claims made against your claim have any merit. Firstly, in the event that your injury did occur at work, then you have a solid means by which to pursue the claim. If your workplace has security cameras, which it honestly should for reasons like this, you can ask to see the footage of the incident. If they refuse to show you, an attorney can then send them a letter demanding that they turn over the tape. This can make a big impact on your case, as a well-worded letter from an attorney will make it very apparent that you mean business.

If the injury did not occur in the workplace, or if you were offsite on a lunch break, you will most likely not be able to collect workers’ compensation. However, that does not mean that it is impossible. For example, if you were injured while offsite, but were offsite as part of your job, that could wind up being covered, though it may be more difficult to make the case due to a lot of the circumstances involved in it. Beyond that, you may also be able to seek compensation in the event that you can successfully argue that an injury or illness was sustained offsite, but due to inappropriate behavior or workplace standards. For example, if someone experiences exhaustion that can be tied to negligence by a superior at your workplace, or if an illness develops at home that was caused at the workplace, you may be able to pursue this claim.

Your injury or illness was caused as a result of negligence on your part

Speaking of negligence, it is not only the negligence of others that you need to take into account when determining the veracity of a workers comp claim. Sometimes, an employer may deem that it was through your actions that the injury occurred in the first place, and that were it not for your actions, you would have not fallen victim to the injury or illness. One common reason for denying this due to your own personal negligence is that they allege you to have been under the influence of drugs or alcohol while in the workplace. This is, of course, a terrible idea on its own, but it should be noted that if it can be shown that you were under the influence, this will make you ineligible to file a workers comp claim. Of course, just because an employer claims that you were under the influence of either during the incident does not mean that you were. Such an allegation would require that they provide substantive evidence, such as a police report that indicates you were under the influence, possession of a drug or alcohol at the time you were injured, and/or an admission by you that you were under the influence. In the event that you were not, you should push back. Not only does it make you lose out on your workers’ compensation benefits, but it also means that you may suffer from a sullied reputation. Consumption of inebriating substances is not exactly the most approved of in a lot of social circles, especially when the accusation is that you were essentially being an unreliable employee.

You did not follow the proper procedures

This is an area where it’s just a matter of bureaucracy getting in the way of the most reasonable outcome. There are certain steps that should be taken immediately following the injuries as well as in the aftermath. The first thing you must do in order to qualify for workers’ compensation is to inform a supervisor or manager, or otherwise ensure that one has been informed in some way. This may be seen as negligent and exacerbating your injury beyond what an employer is obligated to cover if you fail to report it adequately. You also have a time limit on filing, so make sure that you know how your state handles it so you are not taken by surprise by a deadline coming up out of nowhere. You also need to make sure that you go through an approved medical provider, or they may deny you for this as well. However, this in itself may have problems, as the only approved medical providers may downplay your injury, leading you to insufficient payment.

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