It is not uncommon for worker’s compensation claims to be denied.
Denial can be frustrating especially if the person involved has been injured severely and requires expensive treatment.
The reasons for denial could be either valid or invalid. Today we are going to provide you the reasons your worker’s compensation claim could have been denied.
1. You Weren’t Injured At Your Workplace
If you weren’t injured while you were working at your workplace, your claim will most probably be denied.
For example if you were injured while you were out on your break, it won’t count as a workplace injury.
However if you were out delivering something which is work related, you still have a chance at availing worker’s compensation benefits.
2. Nobody Witnessed You Getting Injured
If nobody witnessed you getting injured or there is no direct proof like video footage, your claim has a good chance of getting denied.
Your employer or insurance company might try to argue that it didn’t happen at the workplace. In order to avoid such situations, report to your fellow workers as soon as you get injured.
3. You Waited Too Long To File A Claim
Most states have deadlines of 30 to 90 days to file a worker’s compensation claim after which your claim is less likely to be successful.
Work related injuries should be reported at the earliest otherwise your insurance company will blame your injury on other incidents which are not related to work.
Don’t wait to see if your injury turns into a severe one to file a claim. You could end up losing a lot of benefits if you wait too long.
4. Your Claim Was Poorly Formulated
Your claim will be rejected if it is poorly worded or is incomplete due to lack of evidence and medical records. Your insurance company will thoroughly examine your claim to check for any mistakes or discrepancies which can hurt your claim.
If you are not sure how to make a proper claim and you are in the Wilkes-Barre area, hire a Wilkes-Barre worker’s compensation attorney. He will help you structure your claim properly.
5. Refusal To Provide A Recorded Statement
Your insurance company might compel you to provide a recorded statement which is legally not required for your claim.
If you don’t provide one, the company might deny your claim by stating that you failed to cooperate with them. If this happens you should consult a lawyer and he will help you with your next step.
6. Drugs Or Alcohol Was Involved
If it is discovered that you were high or drunk when you injured yourself at your workplace, your claim will definitely get denied.
Many workplaces have strict rules regarding the consumption of drugs and alcohol at work. Even if you don’t mention it your employer can ask you to get tested for drugs in your medical examination if he suspects anything.
7. You Have A History Of Illness
A history of illness or pre-existing medical conditions can be a reason for the denial of your claim. Insurance companies can use this to their advantage and blame you for aggravating your own condition.
However you are legally entitled to receive worker’s compensation even if you have a pre-existing condition. Such cases can be a little difficult to prove but a good lawyer can help you with your claim.
8. Your Injury Was A Result Of A Fight
If you were the one who started the fight and got yourself injured in the process, there is no excuse for the rejection of your claim.
However if you were forcefully involved in a fight at your workplace which you didn’t start and got injured in the process, you still have a chance of appealing your claim.
9. You Are A Short Term Employee
A short term employment doesn’t justify the denial of your claim. A short term employee is also entitled to worker’s compensation provided they perform the regular duties of a normal employee and meet other state requirements.
If your injuries are not minor, you should get a lawyer to help you in this situation.
If you find your claim getting denied because of invalid reasons we recommend you to hire a worker’s compensation lawyer as soon as possible. He can help you reverse your claim denial and claim your legal rights.