If you had recently experienced an injury or illness at work, you should be entitled to disability benefits from your workers' compensation policy. Unfortunately, some of these claims are denied either by your employer or the insurance company. If this happens, you will need to file an appeal for your claim. Before you do that, it helps to know the reasons why a workers' comp claim might be denied.
Many of the workers' comp claim disputes are not actually from the insurance company but your employer. If they doubt the conditions surrounding the incident, they may deny your claim. Other reasons an employer denies a claim include:
- They don't believe you received the injury while at work
- The injury was on the premises, but not during normal work operations
- They believed you were under the influence of drugs or alcohol
- The severity of your injury is questioned
Failure to Report On Time
It is your responsibility to report the incident to your employer immediately after getting emergency medical treatment, as well as filing the claim in a timely manner. If you fail to let your employer know, they are not able to figure out what happened and if you really got the injury at work. The claim itself must also be filled out on time. Every state has a time limit for filing a workers' compensation claim. If you wait too long, the insurance company can deny it.
There Were no Witnesses
Unfortunately, both your employer and the insurance company can deny a workers' comp claim if there weren't any witnesses. There are exceptions to this, especially if you got a severe injury and it was made obvious what happened, but some injuries need witnesses. If you did not have a co-worker or customer in the area that saw how you got injured, it might be difficult to prove.
There Are Discrepancies
Another reason the insurance company might deny a workers' compensation claim is if there is a discrepancy between your medical records and accident report. The statements made on the accident report must be truthful and in detail. If what you write on the report in regards to the injury and severity is different from what your medical records state, your claim might be denied.
Filing an Appeal
If you believe your workers' compensation claim denial was unjust, you can file an appeal. Before you do so, it is important that you get legal assistance from a workers' compensation attorney, like those at Parker & Frey.Share