5 Most Common Reasons Workers’ Comp Claims Are Denied

Workers’ compensation is an important system that protects employees and employers alike. However, there are times that this system fails one or both parties. If you were injured at work, you likely expected a prompt payout and minimal hassle, which is how it works for many people. What some employees get instead is an ongoing investigation, delayed payments, and never-ending issues.

If your workers’ compensation claim has been denied, find out some of the most common reasons this happens below. For more personalized help with your legal needs, reach out to Weaver Tidmore at 205-980-6065.

1. You Missed a Deadline

There are tight deadlines for workers’ compensation claims. This aims to prevent fraudulent claims and keep employees from popping up years after a supposed injury while demanding payment. If you weren’t prompt about filling out the proper paperwork, reporting the accident, or otherwise documenting your claim, you could give up your right to compensation.

2. You Can’t Prove That Your Injury Was Caused by Work

One of the biggest concerns of workers’ compensation providers is an employee falsely claiming that an accident occurred at work. This is why it is so important to tell your supervisor as soon as an injury occurs. This creates an evidence trail of your injuries and start the process of successfully filing a claim. The longer you wait to report an accident, the more likely it is that your claims will be disputed.

Another issue that may arise is that your injury may not appear to be work-related. If your injury is not one that would typically occur in the course of your daily work tasks, the insurance company may have questions and choose to investigate.

3. Your Employer Believes You Were Under the Influence at the Time of the Accident

Being under the influence of drugs or alcohol at the time of an injury can invalidate your claim, leaving you without income and without any way to pay the medical bills incurred from the injury. This is not difficult to prove; most companies require injured employees to take a drug and alcohol test within 24 hours after their injury. If the test comes up positive for any controlled substances that you should not be on at work, it’s likely that your claim will be denied.

4. You Didn’t Seek Medical Treatment

If an injury is serious enough to request workers’ compensation, it’s serious enough for a trip to the doctor. Some employees skip the medical step entirely, for a variety of different reasons. They may believe that doing so is a favor to their employer, because they don’t need to leave work right away or pay medical bills.

Others are scared of reporting the accident, so they wait until they realize the injury won’t go away on its own. Others simply delay until they find out that they need to see a doctor to get workers’ compensation, at which point it may be too late. Either way, failing to seek medical treatment can seriously damage your workers’ compensation claim.

5. You Didn’t See the Right Medical Care Provider

In a workers’ compensation claim, medical care is directed by the employer or the insurance carrier. If the injury is an emergency, the worker can seek emergency care at the nearest facility. However, in all other situations, the worker has to go to the employer’s preferred primary care provider. From there, the primary care provider will make specialist referrals as is needed.

Sometimes, employees choose to go outside this system, and it often costs them when they try to file for workers’ compensation. If you go to your chosen care provider or anyone not approved of by your employer, you could be left footing the bill on your own and have your claim denied.

Get Help with Your Workers’ Compensation Claim Now

At Weaver Tidmore, we strive to help injured employees get the medical care and income they need while they recover from a workplace injury. If you’re struggling to file a claim or you are experiencing pushback, let us help. Set up a consultation now by calling us at 205-980-6065 or getting in touch online.