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Four common reasons for workers’ compensation claim denials

On Behalf of | Mar 4, 2024 | Workers' Compensation |

If you’ve been injured at work, then you need compensation to offset your lost wages and help you cover your medical expenses. While you don’t have to prove fault in your workers’ compensation case, there are still a lot of pitfalls that can lead to claim denial. Therefore, if you’re not careful in developing your claim, then you could be cut off from receiving the benefits that you desperately need.

Although that’s stressful to think about, there are steps you can take to mitigate the risk of claim denial. Amongst them is educating yourself on common reasons why workers’ compensation claims are denied. So, let’s take a look at some of the reasons why these claims are denied so that you know where you need to pay particularly close attention.

Top reasons why workers’ compensation claims are denied

Remember, your employer’s workers’ compensation insurance company is going to look for any possible justification to deny your claim. Here are some factors they might use to attack your claim:

  • The injury wasn’t work-related: To qualify for worker’s compensation benefits, you have to demonstrate that your injuries were suffered or exacerbated at work. If you were hurt outside of work, then you’re claim will be denied. Your claim will also face an uphill battle if there were no witnesses to your workplace accident or you have a pre-existing injury. So, be cognizant of what your medical records say and who observed your accident so that you can address those issues when they come up in your case.
  • The injury was caused by horseplay: Even if your injuries were suffered at work, your workers’ compensation benefits can be denied if you were engaged in activities that were outside the scope of your employment at the time of the accident. For example, if you’re wrestling around with a co-worker and pull a muscle in your back, then your workers’ compensation claim is probably going to be denied.
  • The injury was suffered when you were under the influence: Your employer probably has strict anti-drug and anti-alcohol use in the workplace. If you’re asked to submit to a drug screen after your workplace accident and it comes back positive, then you’ll be in a hard-pressed position to recover workers’ compensation benefits.
  • Inadequate treatment was sought after the injury: You shouldn’t try to tough out your workplace injuries. Doing so could put you at risk of a denied claim when your injury heals but then later worsens. To preserve your claim, immediately seek out medical treatment and follow your doctor’s orders.

What can you do if your claim is denied?

You’ll obviously want to do what you can to avoid the common causes of claim denial mentioned above. However, if your claim still ends up denied, then be sure to fully consider your appellate avenues. Many workers’ compensation claims end up being granted after an appeal, so don’t feel too defeated if your initial claim is denied.

Without workers’ compensation benefits, you could be left in a dire financial predicament. You might be unable to afford the medical care that you need, and your inability to work might leave you at risk of foreclosure, eviction, or vehicle repossession. You can’t let that happen to you.