No matter where you work or what you do for a living — the worker’s compensation system is complicated. It is rarely a good idea to navigate the complexities without an attorney to advocate for you. It becomes that much more important to have representation when you consider how many reasons, they deny workers’ compensation claims. This article details on What Are the Reasons Workers Comp Claims Are Denied.
It is your right to get help with a denied workers’ comp claim. Worker’s compensation claims get turned down for various reasons that range from simple to severe. A worker’s compensation lawyer will help you navigate a complex process and be there if an insurer denies a claim so that they can appeal for you.
10 Reasons Your Claim Might Get Turned Down
The accident that leads you to finale a worker’s comp complaint has to have happened at work. It includes injuries that occur during breaks and meals. The exception to that rule is if you were on an assignment for work but not actually there. It is a grey area and can get tricky, though, because they will go out of their way to prove you were not at work.
A person must notify their employer in the case of an accident or injury because of several things. First, it is the employer who does an incident report and investigation. A worker’s compensation claim relies heavily on this information. Second, they can outright accuse someone of lying about an injury if it is not reported promptly. And finally, they can say a person is suffering from preexisting health problems, and the incident did not happen during working hours.
A worker disqualifies himself from filing a worker’s comp claim if they are under the influence of drugs or alcohol. Many people are aware of this yet they are still struggling with the urges of their addictions. If this is your case as well, make sure you are preventing relapse because this could cause serious issues with your claim.
One of the most important things someone does after an accident at work or during working hours is visiting a physical or medical professional. Without that initial record, it will be nearly impossible to prove the injury in a worker’s compensation claim. However, there are a few exceptions, like carpal tunnel syndrome, because it happens over time.
However, using a preexisting condition to file a worker’s compensation claim is a big no-no. It means that if you have an injury or illness that started prior and the job did not make it worse will lead to claim denial.
Some companies have a list of preferred physicians. If an injured employee does not get treated by a doctor from that list, the insurance company and employer can deny the claim. The policy behind this decision is not always a good thing for a worker. A doctor that partners with a company might become biased. A worker’s compensation lawyer could advocate and work with a client if they did visit a company-approved medical professional.
The reasons to hire a worker’s compensation attorney outweigh the reasons not to. A complainant has to file their claim in a timely manner. Having a lawyer to advocate for you will reduce the stress of things like deadlines.
Everything has a place and time. Roughhousing and pull pranks at work is never a good thing. If someone sustains injuries while doing things like performing practical jokes, it will disqualify them from worker’s compensation claims. The same rules apply if it was due to a fight that results in injury.
It is the right of an employer to deny any worker’s compensation claim. The likelihood of them fighting it is pretty high, too. Without witnesses or security camera footage, an employer has an easy path to turn down a worker’s compensation claim.
Finally, the most important reason that a claim gets rejected is that an injured worker did not have a worker’s compensation attorney. Lawyers know how claims work and can navigate the system far better than the average person. The right team can help with the entire process, and it is an important step towards a positive outcome.
Know Your Rights
Everyone has a right to seek compensation when injured at work or during work-related tasks. The first thing that everyone should do is get medical attention. Also, the sooner an attorney is in the picture, the faster the entire process will be. One of the mains reasons that the timeframe is so critical is because a company or boss will take advantage of the chaos to find legitimate ways to reject a claim.
Choosing the right worker’s compensation lawyer or firm takes research. You do not want to hire someone without expertise in this area. It will take research to find the right one for you and your needs, but it does not have to be overwhelming.
A lot goes into a worker’s compensation claim. An injured worker must keep up with medical records, witness testimony, CCTV footage, and incident reports. When there is a lawyer in the picture, you can focus on getting well and finding a way to move on from a traumatic accident. It is your right to pursue a worker’s compensation case if it happened at work. Do not let a company or insurance provider try to bully you into signing your right away or convincing you that you do not qualify for compensation. You have the right to appeal a denial with the help of an attorney.
No one plans on getting hurt at work, much less having to sue their employer. But, again, it is your right to file a claim. When the doctor releases you to go back to work, it is your right to return to your position.
Finally, it is your right to pursue disability compensation if the injury keeps you from working. It can be permanent or temporary. Filing disability claims is another reason you need a lawyer on your team. Worker’s compensation cases are complex, but disability cases are more challenging.
Do not let an insurance company or a supervisor talk you out of filing an incident report after an accident at work. It is tempting to give in just so it will be over, but you deserve to see the worker’s compensation claim process through to the end.