Dealing with a denied workers’ compensation claim is frustrating and warrants a call to an experienced lawyer. The workers’ compensation process is complicated, and trying to navigate it alone can result in denied coverage. Let’s explore the common reasons why your workers’ compensation claim was denied:
- The Injury Didn’t Occur At Work
To qualify for workers’ compensation, the injury needs to have occurred at the workplace while you were on the clock. For example, if you fall while completing a project, you’re likely to qualify for workers’ compensation. If an injury happens during a lunch break, however, you may not qualify. A small gray exists where workers are injured while completing an assignment while on the clock but not on the job site (for example, a delivery driver getting into a crash). Likewise, job retreats or conferences can be another gray area, warrantying help from an attorney.
- You Missed Important Deadlines
Deadlines exist for filing your workers’ compensation claim. You also need to inform your employer of your injury and your intent to file a claim in a timely manner as well. Not reporting your injury gives your workplace the opportunity to conduct its own investigation, which can easily be biased. Often, these requirements are missed simply because an employee is unaware of the entire process. A lawyer ensures you fulfill every step meticulously and completely.
- Medical Reasons for Doubt
Employers and their insurance companies may try to argue that an employee had an existing medical condition leading to the injury. This argument may either dismiss a claim outright or limit the amount of compensation an employee may receive. Injured employees are also required to receive medical treatment from the company’s approved list of doctors—though not every company will have such a list. Unfortunately, these doctors can sometimes downplay an employee’s injuries. Regardless of whether or not there’s a list of approved doctors, an injured employee must still receive medical treatment and supply evidence of this when submitting a claim.
- Your Injury Resulted From Some Form of Company Violation
Actions like not exercising proper safety procedures, not wearing the right equipment, or engaging and “horseplay” or practical jokes can cause your claim to be denied. You can also have a claim denied if there’s reason to believe that you were intoxicated or using drugs when the injury happened. Getting into a fight with a coworker also results in denied coverage. All of these are legitimate reasons for having a claim denied, but it’s possible for a workplace to create false allegations against an employee. An attorney can help fight false allegations.
- Your Injury Is Hard to Link to the Workplace
A broken arm due to a product falling from above is fairly straightforward to prove. Developing lung cancer from deadly fumes, however, is much harder to prove. A Newark workers’ compensation lawyer can help injured employees receive the compensation they need when their claim is denied, and our friends at Rispoli & Borneo P.C. agree that having a lawyer is paramount.
