Workers’ compensation is a type of insurance your employer is legally required to carry. And, while you may have been injured on the job, you find your insurance claims denied.
Contrary to popular opinion, filing for workers’ compensation benefits is not as straightforward or even easy as it may seem. If you have been injured at work, then there is a good chance your claim will be denied.
By knowing why claims are denied, you can hopefully avoid your own denial and get the benefits you need for your workplace injuries.
Why Workers’ Compensation Claims are Denied
1. The injury didn’t happen at work: If you’re injured at work, then it is obvious you have a worker’s compensation claim. But, if you are injured off the job site while doing something for work, it is a lot harder to prove your claim. Insurance adjusters will work hard to prove you were doing something other than work-related activities.
2. You were on your way to or from work: If you were injured on your way to work or going home, those injuries are not usually covered by workers’ compensation insurance; therefore, your claim may be denied.
3. There is no medical justification for benefits: Once you have reached your maximum medical improvement level or MMI and you have not returned to work, you could have your future claims denied.
4. You didn’t notify your employer of the injury within the time period required: Workers compensation claims are strict. If you do not file your claim or notify your employer within the required time, then you could have your claim denied regardless if you have a valid injury.
5. You went to an unapproved medical provider: While you can choose which doctor you want to see, there are certain medical professionals not covered by workers compensation – such as acupuncture therapists. If you see one of these unapproved providers, then your claims will likely be denied.
6. You never sought medical treatment: You must seek medical treatment for your workplace injury. If you do not, then workers compensation will deny your lost wages and reimbursement claims.
7. You did not document that it was a work injury: You must have significant documentation when filing these types of claims and if you do not have proof it was work-related, then your claim may be denied.
8. You are filing for a condition you already had: If you have a pre-existing condition and it wasn’t aggravated by your job, you will be denied benefits.
9. You were intoxicated: Workers compensation claims must pay out even if you are at fault for your work-related injury, but there is an exception: If you were working while intoxicated, you are not eligible for benefits.
10. You didn’t hire a workers compensation attorney: Filing workers compensation claims is complex and requires a deep understanding of the local laws. If you don’t hire a lawyer, you increase the chances of a denial.
For Legal Representation! Speak with a Workers Comp Attorney West Palm Beach
Let the team at Scott J. Sternberg & Associates help you with your workers compensation claims. Call a Workers Comp Attorney West Palm Beach today for a free consultation.[sc name=”call-to-action”]