If you’ve recently filed a workers comp claim and it has been denied, I’m sure you’re wondering why. Workers comp claim denial can come about for a number of reasons. Maybe they had a valid reason, maybe they did not. But, your first step, is to rule out any of these potential factors before you pursue another claim or legal action. Following, you will find a list of common reasons for denial of a claim. You might feel that you’re entitled to compensation, and you likely are. But, there could be many factors working against you.
Common Reasons for Workers Comp Claim Denial
You waited too long
Depending on your state, there is a time limit on filing a workers comp claim. The most common time limit is that of thirty days. While you should file a claim and the time of the initial injury, waiting more than thirty days after the fact can severely hinder your changes of receiving compensation. It might also open you up to the possibility of being accused of filing a fraudulent claim. While your injury is very real, waiting to treat it can make those in charge of your claim question it’s integrity.
You were under the influence
Another reason you might face workers comp claim denial, is if you are under the influence of alcohol, or drugs. When it comes to drugs, particularly marijuana— it stays in your system for some time after you use it. So, even if you were not under the influence at the time of the accident— it is still present at the time of the test. Therefore, they have no obligation to treat your injury or pay your claim.
You did not receive medical records
Say that you’ve decided to see a doctor. You will need to provide a medical record before taking the claim any further. It is very easy for your claim to be denied. It is also very easy for the insurance company to claim that you’re faking your injury when there is no medical record of the injury. Your best bet is to see an approved doctor. Make sure that when you do so, you tell them you were injured at work. Lastly, do not leave without documentation of your injury.
You did not receive treatment from an approved provider
Your company’s insurance likely can only operate within a certain network. Same goes with the workers comp system. If you received treatment outside of the approved providers, they might not reimburse for any treatment. Being that they cannot bill it through insurance, or the workers comp system— it is easily escapable.
Your employer says the claim is false
It is not uncommon for an employer to dispute a claim to avoid paying out. They could claim the details are false, you got your injury outside of work, or any number of details. If they feel you’re missing a step, they are likely to capitalize on it. Your best bet is to receive surveillance footage. Or, make sure other coworkers are aware. Even take witnesses if you have them— and contact a lawyer. We would hope any injured party can file an injury claim in a breeze. But, unfortunately, sometimes that is just not the case. In the event that your employer is disputing a claim you know for a fact is not false, it might be time to seek a lawyer.