Reasons Why Your Workers’ Compensation Claim Got Denied

Reasons Why Your Workers’ Compensation Claim Got Denied

While some jobs are more dangerous than others, the truth is that a worker can become injured regardless of the job. The injury can range from something small like a sprained ankle to something far more serious like a traumatic brain injury. Additionally, the injury doesn’t need to be immediate either. Workers can become injured after years of repetitive motions, develop respiratory issues from prolonged exposure to dangerous chemicals, etc. 

Whatever the reason might be, following an injury or sickness of any kind directly tied to work means you’re entitled to seek out compensation. This process involves filing a workers’ compensation claim. Unfortunately, estimates show that around a quarter of workers’ compensation claims are denied when they’re first filed. While there can be numerous reasons why we’ll break down three common reasons. 

  1. Paperwork Issues 

While sometimes an insurance company might question the legitimacy/liability of your claim, other times your claim is simply denied due to minor paperwork issues. These might include: 

  • Missing a certain deadline 
  • Sending in the wrong form
  • Errors such as typos of a wrong date
  • Required information missing 

Unfortunately, even a minor mistake or oversight can cause your claim to be denied or delayed. 

  1. Preexisting Medical Conditions

Just like the question, “what came first: the chicken or the egg?” insurance companies like to ask, “what caused the worker harm: the accident or their preexisting medical conditions?” Just about everybody has preexisting medical conditions of some kind, and they’re not meant to be an automatic disqualifier when you file your claim. 

An insurance company, however, might try to exploit this, even if it means stretching situations to the extreme. For example, did you break your back because you fell off a ladder while working, or did you break your back because you fell off a ladder while working and you suffered from a sports injury several years ago? A lawyer can ensure such arguments are immediately shut down. 

  1. Issues of Liability 

Whether applicable to your situation or not, your claim can be denied if your accident was caused by neglect on your part. For example, if the accident occurred because you weren’t complying with your company’s and state/federal guidelines and regulations, your claim can be denied. This might be as simple as not having another crew member present when performing an action or can be exhibiting extreme negligence like “horseplaying” while on the job. 

However, the intention is also a factor. A worker can be directly responsible for their injuries while also having good intentions. 

For example, maybe your job involves driving a van and in order to avoid hitting a pedestrian or another vehicle, you quickly swerve. In the process, you break several limbs. While your injuries are directly your fault, your intention for causing the accident was to save another person’s life. In such a scenario, you could still be entitled to workers’ compensation. 

Having a workers’ compensation claim get denied can be a frustrating and stressful experience. To prevent a denied claim or to work through the appeal process, a workers’ compensation lawyer can help. Our friends at Therman Law Offices, LTD has a team of lawyers ready to assist! 

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