Workers’ compensation provides a much needed lifeline to those who are injured on the job. It allows them to continue living the life they are accustomed to and focus on recovery without having to worry about their financial situation. Unfortunately, workers’ compensation claims can be denied. When this happens, the injured party is often left in dire circumstances. In this guide, we will cover all of the most common reasons workers’ compensation claims are denied, helping you to avoid them should you be injured on the job.
Failure to Report Injury In a Timely Manner
When injured on the job, you have a window in which to report it to your employer. Missing this timeframe will result in your claim being denied. How long you have to report will vary based on the state you are in. For example, under Massachusetts workers’ compensation law, an employee has 7 calendar days from the injury, or from when they realize the injury is work related, to report it to their employer. If injured on the job, it is important to keep this time limit in mind. It is all too easy to get swept up in the aftermath of an injury and forget to report it to your employer.
Lack of Medical Evidence
It is not enough to say that you were injured, you must be able to prove it. This is done through medical documentation. It is extremely important that you visit a doctor so that your injury can be properly documented. Additionally, keep meticulous records of your medical visits so that you will have evidence. A lack of medical evidence can easily result in your claim being denied. This is why you must go to the doctor even if your injury is relatively minor.
Pre-Existing Conditions
When it comes to workers’ compensation, a pre-existing condition is any health issue, illness, or injury you had prior to the work-related injury. It is extremely common for insurance to deny a claim based on a pre-existing condition. For example, if a person has a history of back pain and then injures their back at work, insurance may claim that the work injury is just their pre-existing back pain. Medical documentation is extremely important to ensure this does not happen. It should be noted that worker’s compensation can cover a pre-existing condition, if it can be proven that a work injury aggravated the condition.
Missing or Incorrect Paperwork
A worker’s compensation claim is made with a form provided by your employer. Failure to fill out this form will result in a claim denial. Additionally, incorrectly filling out the form can also result in denial. For this reason, it is extremely important that you double check all paperwork to ensure it is free of errors. It is also vital that you are completely honest and do not embellish the severity of your injury.
Evidence of Fraudulent Claim
Unfortunately, many people try to fraudulently claim workers’ compensation. You do not want to be mistaken for one of these people and have your claim denied. The insurance company will investigate and try to find evidence that you are either lying about your injury entirely or exaggerating its severity. For this reason, you should be extremely careful of what you post on social media and do in public. You do not want it to seem like your injury is not affecting you or preventing you from engaging in physical activity.
Making Sure Your Claim Isn’t Denied
The best way of ensuring your claim is successful is to hire a workers’ compensation lawyer immediately after your injury. They will help you to gather the evidence needed to give your claim the best chance of being successful. In the event that your claim is denied, your lawyer will help you to appeal it, fighting for you to ensure you get everything you are entitled to.
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