Any employee hurt on the job has the legal right to file a compensation claim that will cover the costs related to their injury or illness while compensating them for any lost wages due to time off from work.
Unfortunately, most employers and their insurance companies are notorious for going to lengths to invalidate and turn down compensation claims to avoid paying the victim the benefits they are entitled to.
This article will put forth 6 of the most common reasons for workers’ compensation claim denials by employers or insurance carriers.
Reasons for Workers’ Compensation Claim Denial
While you possess the right to appeal, it is crucial to know why your claim may be denied. Some reasons include:
1. Exaggerating a Claim
Being dishonest by exaggerating the severity of your illness or injury may affect the benefits you receive or perhaps prohibit you from claiming compensation entirely, regardless of whether you have been genuinely hurt.
Therefore, it is essential to be honest about the extent of your injuries and be consistent with each detail when explaining the details to your employer and doctors.
2. Willful Negligence
Another common reason for workers’ compensation claim denial is willful negligence, which refers to harm caused by the victim due to their own negligence or by engaging in reckless behavior.
An employee whose workplace injuries are determined to be caused by willful negligence, such as horseplay, failing to follow safety regulations, or working while intoxicated, is likely to have their compensation claim denied.
3. Not Informing Your Employer
An essential aspect of enhancing your chances of receiving maximum benefits out of your compensation claim is to inform the employer of your injury or illness as early as possible.
Waiting too long and not immediately reporting the incident to your employers conveys the impression to the insurers that you did not get hurt, or perhaps the injury may have occurred at some other time or place.
By officially notifying your manager or supervisor in writing and filling out a detailed accident report, your employer is responsible for investigating the accident and working with the insurance provider to provide you with the timely compensation you deserve.
4. Expiring Statute of Limitations
Each state has its statute of limitations, typically 2-3 years, within which you must file a benefits claim. The statute of limitations is a law that sets the maximum time limit within which a plaintiff is eligible to initiate legal proceedings.
Accordingly, you must file a workers’ comp claim within a certain period, as defined by state law. Failure to do so within the specified window may restrict you from receiving maximum benefits or even make you ineligible to claim compensation altogether.
5. The Injury Occurred While Under the Influence of Drugs and Alcohol
When you get injured at work, you will likely have to visit a medical professional for a thorough evaluation, including a test of alcohol or drugs as requested by your employer.
If your medical tests reveal you were under the influence of illegal drugs or alcohol at the time of the accident, you will not be entitled to file a claim and receive compensation, no matter how serious your injury may be.
Workers’ compensation laws do not cover injuries caused due to intoxication or drug use while at work.
6. The Injury Is Not Work-Related
It is all too common for employers to dispute a claim based on the argument that the employee’s injury occurred outside of the workplace or is perhaps a pre-existing condition. They may argue that the injury occurred outside the scope of employment or because of a prior condition and the job did not aggravate it, resulting in your compensation claim denial.
What To Do After Your Workers’ Compensation Claim Denial
A workers’ compensation claim denial will initially be a setback, but if you still believe your injury makes you eligible to receive compensation, it is in your best interest to not panic and seek legal representation as it may not be a lost cause just yet.
You have the option to appeal the decision, and hiring an experienced and skilled personal injury attorney will help in determining the best course of action in your case.
An attorney can negotiate with the insurance carrier for a settlement or take the matter to trial if needed, significantly enhancing your chances of receiving the workers’ compensation benefits you deserve.
If you’re ready to speak to our legal team about your workers’ compensation claim denial, contact Mottaz & Sisk Injury Law today.