What Are the Reasons Workers Comp Claims Are Denied?


Insurers deny many legitimate workers compensation claims, and it forces innocent and honest employees to hire workers’ compensation lawyers at Feroleto Law. There are a number of reasons why a claim might be denied.

The Injury Wasn’t Witnessed

Insurance companies don’t like injuries that aren’t witnessed. They will question the majority of unwitnessed accidents. If you get hurt at work but no one saw your accident, there isn’t anything you can do about it except be sure to report the injury to your supervisor and co-workers immediately. When reporting your injury, make sure that you tell everyone the same thing about how your injury happened.

You Didn’t Report Immediately

If your injury goes unreported for a while, insurance companies also don’t like this. They will assume if you didn’t report your injury as soon as possible then you weren’t really hurt. You are required to report work-related injuries within a short time period so don’t wait. If you did get hurt at work and think there is even a chance that the injury could cause you to miss work, you need to fill out an accident report and report it to your supervisor immediately.

Discrepancies between Initial Medical Records and the Accident Report

The insurance company will typically deny the claim if the statements about how the accident occurred aren’t consistent. If you tell a supervisor, the accident happened in one way but then tell a doctor that it happened some way else then this hurts your case and increases your chances of a denial. No matter who you tell, whether it’s medical personnel, co-workers, or supervisors, be sure you are consistent in how the accident occurred.

First Medical Records Show That There Are Illegal Drugs in Your System

If you are in the emergency room after a work-related accident and the records from the emergency room show that there are illegal drugs in your system, then the insurance company isn’t going to voluntarily pay compensation benefits.

You File a Claim after You Are Laid Off or Fired

Sometimes an employee can be legitimately injured at work but delay filing a claim. When he or she does end up filing the claim they are already laid off or fired. Insurers don’t like claims that come in after the employee is laid off or fired. They will assume that the claim is more for revenge. This is just another reason why you don’t want to wait to file a claim if you do in fact have a legitimate work-related injury. If you do happen to get laid off before you file, you are going to have a harder time convincing the insurance company or judge that you did have a real work-related injury.

You Refuse to Sign Medical Authorizations or Don’t Give the Insurance Company a Recorded Statement

Insurance companies will ask injured employees to give a recorded statement to describe the injuries and the accident. However, this does put the injured employee in a hard position. As a general rule, it’s not a good idea to give a statement, especially if you don’t have a lawyer. The employee isn’t also legally required to give a recorded statement to the insurer. If the insurer does want a statement, it can be a sign the company has a problem with the case. If the employee does give a statement, it doesn’t mean that they will automatically get the benefits they deserve. However, if the employee does refuse to give a statement, then the adjuster has a reason to tell the employee on why the claim was denied. Insurance companies also will typically ask employees to sign a medical authorization to allow the insurer to write to healthcare providers and get bills and medical records. Just like with a statement, there is no legal obligation to sign a medical authorization. While the injured employees have an obligation to give bills and medical records to the insurance company, he or she can do this by getting their own records and then send them to the insurer. However, insurance companies don’t like this since they don’t want to trust injured employees. They want to get medical records on their own so they can get the complete file. The issue with medical authorization forms is that insurance companies may get records not related to a work accident.

Like it? Share with your friends!



Your email address will not be published. Required fields are marked *

error: Hey Butler Content is protected !!