Why is Workers Comp Claim Denied?

You got hurt at the work and doctor told you to stay at home so you could recover.

Time to sit back and let those workers comp check come in!

In some cases, this is exactly how workers compensation works.

But for some , their case ends in a workers compensation denial.

Every situation, employer, injury, and insurance company are different, but here are 10 reasons workers comp claim denied.

10 Reasons Workers Comp Claim Denied

1. No workplace injury

The injury must have occurred during the course and scope of your employment, And the injury must arise out of the employment.

If the injury happened outside of work, or if you’re faking your injurie altogether, your workers comp claim is likely to be denied.

2. Your injury isn’t covered

Workers comp isn’t a government funded program, but a type of insurance policy.

And just like your auto or homeowner’s insurance policy, certain things might not be covered.

For example, in most cases, mental health is not covered by workers comp.

So even though a stressful work environment might be to blame for your depression and anxiety, your workers comp claim for psychiatric care will probably be denied.

3. Waiting to report the injury

You only have 30 days following your injury to file a workers’ comp claim.

If you let this time pass without notifying your employer or the insurance company, you should expect your claim to be denied.

4. No witness

An injury with no witness or video footage is more likely to raise suspicion, as there is no one to back up your claim that you were injured at work.

This is not guaranteed that your claim will be denied, but is one of the number one reasons workers comp claim are denied.

5. Discrepancies in your report

Before they accept or deny your workers comp claim, the insurance company will carefully review all of the evidence available to them.

If there are discrepancies between the report you filed at work and your medical record, they are likely to support a fraudulent claim.

6. Pre-existing condition

Often, workers’ comp claim are denied because of pre-existing condition.

But the truth is, if a workplace accident makes pre-existing injury worse, you are still entitled to workers’ comp benefits.

Generally speaking, if you sustain an injury at work, as long as you are in the course and scope of your employment and the accident at work is greater than 50% of the cause of the injury you sustain when compared to all other contributing causes, you should be able to secure workers’ compensation benefits.

7. Lack of cooperation

In some cases, you may be contacted by the insurance company to provide a recorded statement describing your accident and injuries.

At other times, the insurance carrier may required you to sign a medical release form allowing them to contact your doctor directly for your medical records.

It is well within your legal right to refuse to give a recorded statement or sign a medical release.

But doing so might lead to your claim being denied because you didn’t cooperate.

If that happens, contact a workers comp attorney immediately.

8. Intentional injuries

Ignoring safety regulations can reduce the amount of benefits you receive

Furthermore, intentionally hurting yourself and accidentally injuring yourself while participating in “horseplay” are not compensable.

9. Illegal drugs

Your employer may have all employees take a drug test following any workplace accident.

If illegal drugs are present our workers comp claim will be denied.

10. You were the aggressor in the fight

The aggressor in a fight is never entitled to any workers compensation benefits.

If you’re the aggressor in a fight at work, your claim will be denied.

If you are not the aggressor, however, you may be entitled to workers’ compensation benefits.

The question is: What started the fight?

Final Thoughts: 10 Reasons Why Workers Comp is Denied?

If you believe your workers comp claim was unfairly denied, you have the right to fight back.

If you have filled a workers’ comp claim, you can be sure that the insurance company has their own team of legal professional ready to back up the workers compensation denial.

Don’t go up against them without an attorney on your side!

I hope now you have a clear about the 10 reasons why workers comp is denied.

Having any question or doubts, please feel free to comment below!

FAQs

*Reference: https://www.dir.ca.gov/dwc/MyClaimWasDenied.htm