Workers Comp Denial? Here’s Why And What To Do

When you suffered an injury at work and your filed a workers compensation claim, you may have assumed that you would get your medical bills and other injury-related bills taken care of without any trouble. However, there is not always a guarantee when it comes to workers compensation claims and you may have instead received a denial notice for your claim. Before you give up on the issue, get to know some of the reasons that your claim may have been denied and what you may be able to do about the issue. Then, you can be sure you understand what is going on and that you have exhausted all of your options before you give up trying.

Your Statements About the Accident Were Somehow Inconsistent

After you suffer an injury at work, it is understandable to most people that your thoughts and memories are a bit jumbled or confused. This is especially common with major injuries or head injuries. However, insurance companies as well as your employer will still want a statement about what happened (i.e. how the accident occurred in as many details as possible) as soon as possible. In fact, they may even ask for your statement immediately after it happens.

Once you arrive at the hospital or the doctor's office, you will once again be asked what happened during the accident. If these two statements differ, your employer's workers' compensation insurance company may deny the claim. They will assume that an inconsistency in your accounting of the event means that you are being dishonest and wrongfully trying to blame your employer for an injury that occurred due to your own negligence rather than in the proper line of duty.

Of course, this is not likely what you have done or intended and there are ways to appeal such a denial with the help of a work injury lawyer. If you did suffer a head injury or any type of major trauma, you may be able to get your doctor to attest to that fact and therefore provide a likely explanation for any variations in your account of the accident. Additionally, if there were witnesses or security camera footage of what happened, you could also present this as evidence for your appeals case.

You Lost Your Job Before Filing the Claim

If your workers' compensation claim did not get filed before you left your job or lost your job with your employer, the insurance company may deny the request as well. It is basically the job or an insurance company to assume the worst in people. The fact that the claim came in after you were no longer employed with the company would indicate to them that you are doing so out of spite or for malicious reasons. Of course, most people would never do that but if you want to pursue an appeal, you will need to develop an argument as to why this is not the case.

When your claim is denied for this reason, you and your work injury lawyer may want to meet directly with your former employer rather than go to court. You and your employer (and the insurance company) may simply need to sit down and have a conversation to come up with a settlement and clear up any misunderstandings. However, if your employer is unwilling to do so or talks do not come up with a solution, you will need to gather evidence about your injury proving that it qualifies for workers' compensation and go to court.

With these possible denial causes in mind as well as what you can do about them, you can be sure that you do everything you can to get your workers' compensation claim approved after a denial.