Why Your Workers Compensation Claim Can be Denied

The United States government put in place the worker’s compensation act, a system of rules used to pay or compensate an employee if they sustain a work-related injury. With this law, employees can claim medical expenses, lost wages, disability payments, and any other cost related to the accident or injuries sustained.

Every employee is entitled to compensation if they can prove that they were injured while at work and that their employer is liable for their injuries. This is not always easy or straightforward. There are exemptions to the claim, and, sometimes, the victims can make some mistakes, which can affect their claim.

If you have been in a workplace accident, get in touch with a workplace accident lawyer from Pathfinder Injury Law to know how you need to help preserve your claim. Though workers compensation is a no-fault system, a claims process can be very long, and the claim can also be denied. 

Here are some of the common reasons for the denial:

Failing to Report the Accident or Injuries on Time

If you have been in an accident, you should immediately report to your supervisor or manager. This is never easy, especially when it comes to injuries that involve occupational illness or repetitive stress injuries that might take the victim some time to discover. 

Every state has a deadline for reporting work-related injuries and employers are also required to take the right steps to mitigate risks and allow you to seek medical attention. 

Insurance companies are always looking for ways to deny a claim, and if you fail to report your injury on time, they will use that against you.

The Injury Did Not Happen at Work

You are only entitled to workers compensation if the injury occurs while you are at work or while performing work-related duties, such as running an errand for your employer. If you cannot prove that you were working at the time of the accident, your claim can be denied.

However, there are a lot of grey areas in this. For example, if your employer sends you to run an errand while you were off the clock and you get involved in an accident, you can still be entitled to compensation if they can confirm your story.

You Failed to Go to the Hospital

It is impossible to prove injuries without a doctor’s report. The insurance company can claim that you are faking your injuries or your injuries are not as severe as you claim and deny the claim. They can also argue that you failed to mitigate the extent of the injury.

Therefore, it is important to seek medical attention immediately after an injury. Remember, you cannot know how serious your injuries are or might be in the future if you fail to go to the hospital.

You Were Intoxicated

Your employer can claim that you failed to use reasonable care at the time of the accident because you were intoxicated. Though it is illegal to test employees for drug and alcohol abuse in some states, OSHA guidelines allow such tests to be done if there is reason to believe that it contributed to the accident. 

The Illness or Injury Resulted from a Pre-Existing Condition

The insurance company can also question the origin of your injury or illness. For example, if you claim you sustained a back injury while lifting a heavy box at work, they can claim that the back injury already existed if they can prove that you have been seeing a chiropractor and deny your claim.