Top 10 Reasons A Workers’ Comp Claim Is Denied: What You Need to Know

A staggering number of workers’ comp claims are denied every day. As a result, many employees are in the dark about what to do next. Before you can worry about that, though, you need to know what caused your claim to be denied at all. There are many reasons a workers’ comp claim can be denied.

Injuries Not Work-Related

If your injuries or disability are not work-related, you cannot claim workers’ comp. Injuries sustained outside work, from acting against the instruction of your employer while on the job, and preexisting conditions do not qualify. For approval, you need to prove that your injuries are a direct result of your employment.

Intoxication/Substance Abuse

Being under the influence of alcohol, or any illicit substances, while on the job is not allowed. Thus, you cannot receive workers’ comp for injuries caused by intoxication or substance abuse. To receive workers’ comp, liability for your injuries must fall on the employer.

Not Treated By Approved Provider

To claim workers’ comp, injured employees must receive proper medical care from an approved provider. This helps prove the cause of injury. Not having a record of care or an approved provider can result in the denial of your claim.

Missed Deadlines To Inform Employer/File Claim

When filing workers’ comp claims, meeting deadlines is crucial. A claim can be denied if the employer is not notified of an injury within the 90-day reporting period, or if a claim is not filed within two years of the date of the injury. For better success, pay attention to these, and other, deadlines.

Minor Injuries

To receive workers’ comp, an employee must be too injured to continue working. If your injuries are minor, and you don’t need much medical care or time off, you will not qualify for assistance. Workers’ comp is only for those who are seriously injured or disabled.

Light Duty Refusal

If you’re injured on the job, you may be offered what’s known as “light duty.” This type of employment offers easier work meant to accommodate your injuries. Refusing light duty, though, can result in denial.

“Independent” Medical Examinations

Insurance companies love to use “independent” medical examiners to avoid paying workers’ comp. Their bias, though, can affect the approval of your claims. To make sure you’re not unfairly denied, you need an unbiased medical examiner.

Disputed Claims

When you report a workplace injury, your employer has a right to try and dispute your claims. If an employer is successful in disputing your claims, you will not receive workers’ comp. This is why having sufficient documentation of your injury and loyal medical examiners are so important.

Post-Injury Wage Earning Capacity

It’s common for insurance providers to try and use post-injury wage earning capacity (PIWEC) rates to reduce/avoid workers’ comp. They will try to claim you’re only partially disabled, and thus capable of finding work elsewhere. The only way to avoid this is to have experience workers’ comp attorneys fight for what you deserve.

You Didn’t Trust Aiello Law Group

Getting your workers’ comp claim approved is all about having the right attorneys. The right workers’ compensation attorneys, like ours at Aiello Law Group, will help make sure you have everything you need to evade denial and secure your benefits. To get started, reach out to Aiello Law Group. Call us, today, at 313.964.4900 or fill out the form in the sidebar or on our contact page, and learn more about how we can help you.