5 Common Reasons Workers Comp Claims Are Denied

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Worker's compensation benefits are paid out to an employee by the employer's insurance company when the employee is injured on the job. However, it's not as simple and becoming injured and then collecting your checks. There is a claim filing process that might be easy in some cases, but completely daunting in others. There seems to be a trend with denials, such as age, tenure, and wage, and you need to fight that trend. 

There are times when completely legitimate worker's compensation claims get denied, and if you plan on filing for worker's comp, you need to know about them so you can be prepared.

1. Pre-existing Conditions

Sometimes the insurance company will look for pre-existing conditions to blame the injury on. They figure that your condition worsened or did something to cause the accident. Even if they don't really believe that, it's a good enough reason as any to deny your claim (only in their eyes, of course). At this point, you need to retain a lawyer if you haven't already. This doesn't mean that you won't receive your money, you might just need to fight a more difficult battle. You worked for years with this pre-existing condition without it being an issue, and your lawyer will prove that it had nothing to do with your new injury.

2. Not Seeing Your Own Doctor         

After your injury, you will be given an appointment to see one of the insurance company doctors to verify your claim. While no one is accusing these doctors of being dishonest, anyone can admit that it's a little suspect to be examined by someone who is paid by the people who would rather deny your claim and save the money. You need to find out what your state laws are about seeing your own doctor. Some will let you see your own doctor right away while other states have a waiting period. If you can see your own doctor at any time for a second opinion, make sure you do it.

3. Private Investigators

It's common for worker's comp insurance companies to hire private investigators to survey the person who made the insurance claim. They do this to make sure the person isn't faking the injury. Someone could've been watching you do something that was taken out of context or made into a bigger deal than it is. If you did something as simple as run an errand, they might say that you can work if you can go to the store—even though buying a gallon of milk and working an eight-hour shift are two very different things. Make sure you hire a lawyer to argue your case.

4. Bad Timing

Sometimes coincidences happen that make people look bad, but it's no one's fault. If you just asked for vacation time that got denied, they could assume that you are faking your injury to get that vacation time after all. If you injured yourself on a Monday, they could assume that you were trying to get out of work the rest of the week. These assumptions are unfair. You can't help if you hurt yourself on a Monday morning right after you clocked in or two days before your daughter's destination wedding.

5. Waiting too Long to Report

Sometimes people don't report injuries at work because they don't seem like a big deal at the time. It isn't until a few days later when they realized that they hurt themselves much worse than they originally thought. However, employers require that all injuries, even seemingly minor ones are reported immediately, and while that may seem like a hassle, it benefits you, as well. If you didn't report it immediately, it could have caused your claim to get denied, because unless there is video footage, you can't prove it even happened at work.

As you can see, applying for workers compensation can be difficult and frustrating. Make sure you understand these reasons for denied claims so you can avoid them. Get a lawyer to get your hard to place workers compensation since they will have the resources and knowledge to help you win.

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29 February 2016