A workplace injury can wreak havoc on your life. To start, it can leave you unable to work, which can quickly cause you to burn up your paid time off, leaving you without a way to earn income. On top of that, you’ll have to secure medical care that can prove enormously costly, even if you have insurance coverage. All of this can lead to stress and a sense of being overwhelmed.
Fortunately, the workers’ compensation system might provide you with the relief needed to put you on a path to recovery while stabilizing your financial well-being. While you don’t have to prove negligence to secure workers’ compensation benefits, many of these claims are denied. It’s a good idea, then, for you to educate yourself on some common reasons for claim denials, that way you can work to head them off before they attach to your claim. Let’s get started here.
Common reasons for workers’ compensation claim denials
It may not seem like it at first glance, but there are several justifications that insurance companies can rely upon to deny workers’ compensation cases. These include:
- The medical condition isn’t work-related: To obtain workers’ compensation benefits, your injury or illness has to be tied to your work. If the insurance company can show that you had a pre-existing condition that wasn’t exacerbated by your job and that’s the cause of your current situation, then they’ll deny your claim for workers’ compensation benefits.
- You were engaged in horseplay when you suffered your injuries: Even if you were hurt at work, you won’t be granted workers’ compensation benefits if your injuries were attributable to activities outside the scope of your work. For example, if you and coworker were wrestling at work and you broke your arm as a result, your employer and their insurance company are going to fight tooth and nail to avoid paying you workers’ compensation benefits.
- You didn’t report the injury in a timely fashion: If you’re going to seek workers’ compensation benefits, you have to report your injuries to your employer within a specified period of time. If you don’t, then your claim will be automatically denied, and you’ll be left without the financial resources that you need.
- You were under the influence at the time of the workplace accident: After being injured on the job, your employer may require you to submit to drug and alcohol testing. If they find that you were under the influence at the time of the incident, then they’ll deny your workers’ compensation claim outright.
- You sought inadequate or no medical treatment: When filing a workers’ compensation claim, you need medical evidence to back up your position. If you try to tough out your injuries and forego seeking medical treatment, then the insurance company will probably try to argue that you lied about your injuries and will therefore deny your claim.
Maximize your chances of recovering workers’ compensation
There are a lot of challenges to confront when pursuing a workers’ compensation claim. If you don’t know how to tackle them, then your claim can be denied, and you could be left without the financial resources necessary to spur your recovery.
That’s why it’s critical that you develop a strong legal strategy going into your workers’ compensation case while keeping an eye on potential denial justifications that may arise in your case. By doing so, you can anticipate the arguments that you’ll need to fight back against and can thereby develop compelling counterarguments.