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Top 6 Reasons Workers’ Compensation is Denied

Posted on Sunday, July 22, 2018
Workers' Compensation

The workers’ compensation system is complicated, and although most claims go relatively smoothly, some valid claims get denied, for any number of reasons. Here are 6 explanations of why your workers’ compensation claim was denied:

1 – You Were Injured, But Not at Work

To be eligible for workers’ compensation benefits, a worker must have been injured while in the course and scope of their employment. Under workers’ compensation law, benefits are available to a worker who is hurt on the job, and no proof of fault needs to be made for benefits to be paid. All that needs to be established is that the injury occurred on the job and is connected somehow with the work the employee performed. But if the injury occurred while you were at lunch or running a personal errand, you most likely will not be eligible for workers’ compensation benefits. However, if you were on a work assignment outside the workplace, you could have a valid claim.

2 – You are an Independent Contractor Instead of an Employee

While employers are required to provide workers’ compensation benefits to employees, no such requirement exists for independent contractors. Generally, an employer-employee relationship exists if a worker performs services that can be legally controlled by an employer, such as what will be done and how it will be done, even if the worker is given freedom of action. An individual is an independent contractor if the person paying him has the right to control or direct the result of the work, but not how the work will be done. So if you are an independent contractor, you most likely aren’t covered by workers’ compensation law and entitled to benefits.

3 – You Didn’t File Your Claim in a Timely Manner

Under workers’ compensation law, an injured worker is required to file, in writing, a First Report of Injury within a specified time limit – as soon as possible and usually no later than 30 days after the incident, and failure to do so has different penalties, according to state law. The deadline for filing a workers’ compensation claim can vary from 30 days up to several years, again depending upon state law, and the time limit typically begins on the date of the accident and can be extended to accommodate payment of medical bills or lost wage benefits.

4 – You Weren’t Treated By a WC-Approved Medical Provider

According to workers’ compensation law, you don’t get to choose who provides treatment for your work-related injury – your employer and the insurance company do. You will receive a list of approved doctors that you can seek treatment from, and as long as you visit one of them, workers’ compensation will pay for your medical treatment. Unfortunately, many of these doctors devote their entire practices to performing Independent Medical Examinations for workers’ compensation carriers, and they often downplay your injuries, resulting in decreased benefits for you. If you did not receive any medical treatment for your injury and consequently have no medical records to document your claim, it will most likely be denied because you have no proof.

5 – There Were No Witnesses to Your Injury

Because fraudulent workers’ compensation claims have become relatively common, employers and insurers are usually somewhat wary about a workers’ compensation claim involving an injury that no one witnessed, which is a great disadvantage to those who work alone. If you were injured at work but no one witnessed it, there is nothing you can do about that, but you should immediately report the injury to your co-workers and supervisor, and make sure your paperwork accurately reflects how the accident occurred.

6 – You Didn’t Have a Workers’ Compensation Attorney

While you’re not required to retain an attorney to file a workers’ compensation claim, having one will dramatically increase the chances that your claim will be successful. An experienced workers’ compensation lawyer will guide you through the process, help you fill out the required paperwork, and recommend the documents that you will need to prove your claim.

Even if your claim has been denied, it’s not too late to contact a workers’ compensation attorney begin the workers’ compensation appeals process. For expert legal advice in workers’ compensation matters, contact DDB Law online or call 888-648-5999 to schedule your free initial consultation today.