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5 Reasons Your Works Comp Claim Was Denied

Workers' compensation is a financial mechanism put in place to help out honest workers that are injured on the job. In theory, if you are working responsibly, not neglecting your duty or the quality of your work, and you are injured at work through no fault of your own, a claim for workers' compensation can help you to handle the finances of medical treatment or lost wages during recovery.

However, even if you think you did everything right, your claim may not be approved by the insurance company. Why? Here are the four most common reasons.

No One Saw It

As with a trial in court, evidence matters. Even if you are legitimately injured at work through no fault of your own, making that claim will be difficult if there are no witnesses to back up what happened. This is especially true in situations where an investigation of the accident site doesn’t yield any evidence that backs up your claims. Unfortunately, bogus claims, with no witnesses, can and do occur, so even if your claim is legitimate, a lack of witnesses makes it a difficult battle.

You Fail A Drug Test

In some cases, an accident—such as a traffic accident—may require some tests for the presence of drugs or alcohol. Even if an accident wasn’t your fault, if you submit to a drug test, and the presence of suspect substances is found in your system, this could indicate that even if you’re not aware of it, due to lapsed judgment from substance use, the accident could possibly be your fault after all.

The Stories Don’t Match

It’s important to get the details right. If you get into an accident and you make a statement that it happened one way, then go to your doctor and give a different story, that’s a discrepancy. Insurers are extremely cautious of inconsistent explanations since there’s always the possibility that this means deception is involved. Always make sure when you explain what happened, that explanation is both honest and consistent.

You Don’t File For An Injury Right After It Happens

Under ordinary circumstances, if you’re injured, you’ll normally want to seek treatment and get the compensation for that treatment as quickly as possible. This is why a claim may not be approved if you make it well after an injury has occurred.

The likelihood of approval is even lower if the file for a claim comes after a job loss, such as being laid off or fired. Even if you’re not sure that you have injury that requires treatment, it’s better to be safe than sorry, and seek medical evaluation, rather than realize after it’s too late that you need to file a claim.

You Refused To Give A Statement Or Authorization

This is, unfortunately, a bit of a catch-22 situation with insurance companies. Legally, the only description of your injuries you need to give is to your doctor when being evaluated and treated for injuries. However, in some cases, the insurance company that handles workers' compensation may want a recorded statement of your injuries to compare with final treatment. They may even ask for medical authorization to go directly to your health records and examine your medical history themselves.

In both cases, you are not legally obligated to comply. However, even if it’s not illegal to refuse, the insurers may deny a claim based on your refusal to comply. This can be a tricky situation if you don’t like the invasion of privacy.

However, even if a claim is denied, all is not lost. You can always challenge this decision by talking to an experienced workers' compensation lawyer and to get what you deserve.