If you have been injured on the job, you may be eligible to receive workers’ compensation benefits. But, unfortunately, many workers’ comp claims are denied and it can leave people feeling frustrated and helpless.
In this article, we will explore some of the most common reasons why, as well as what to do if your workers’ comp claim is denied. Knowing these potential pitfalls can help you avoid them in order to get the financial support that you need after an injury at work.
Overview of Workers’ Compensation Benefits
Workers’ compensation benefits are designed to provide financial and medical support for workers who suffer an injury or illness related to their job. These benefits can include medical expenses, lost wages, and other costs associated with the injury. In order to receive these benefits, the injured worker must be able to prove that the injury occurred in the course and scope of their employment.
Unfortunately, many workers’ comp claims are denied due to various reasons. Knowing these potential pitfalls can help you avoid them in order to get the financial support that you need after an injury at work.
5 Common Reasons Why A Workers’ Comp Claim Is Denied
1. Inaccurate or Outdated Information on the Workers’ Compensation Claim Form
One of the most common reasons that workers’ comp claims are denied is because the information on the claim form is inaccurate or outdated. For example, if you’re filing your claim after two years have passed since the date of injury, or if the date of the accident is incorrect on the incident report, your claim will likely be denied. It’s important to make sure all information on your workers’ comp claim is accurate and up-to-date.
Failure to Report Injury Immediately
In order for a workers’ compensation claim to be approved, you must report any workplace injuries as soon as possible after they occur. If there is a significant delay in reporting an injury, it can cause your claim to be denied.
2. Incorrectly Filed Workers’ Comp Claim Forms
Another common reason why workers’ comp claims are denied is due to incorrectly filed forms and paperwork.
It is important to take your time when filling out the forms in order to make sure that they are filled out correctly. Even slight errors in the paperwork can lead to a denial of the workers’ comp claim. Make sure to check for typos or inaccurately filled information before submitting forms.
Additionally, be sure to include any relevant evidence such as pictures, documents, or medical reports when submitting your claim. This can offer further proof that your claim is valid and should not be denied due to incorrect filing procedures.
3. Medical Records Do Not Support Your Work Injury Claim
Your medical records must support your claim that the injury or illness was caused by work-related activities in order for workers’ compensation to be approved. If the medical records submitted with a workers’ comp claim do not support the injury or illness, then the claim may be denied.
It is important to be outspoken and thorough regarding your symptoms. If there are inconsistencies between what is reported on the form and what is stated in the medical record, this could lead to denial of the claim as well.
Make sure to provide accurate and thorough information regarding your illness or injury when submitting a workers’ comp claim in order to increase your chances of success.
4. Employer Disputes the Cause of Your Work Injury
If an employer disputes the cause of an injury, it could potentially lead to a workers’ comp claim being denied. In these cases, the employer may attempt to prove that the illness or injury is due to something other than work-related activities.
Evidence such as medical records and witness accounts can be used to support or dispute claims, but if the employer can prove that the illness or injury was not caused by working conditions, then you can end up with your workers’ comp claim denied.
5. You Engaged in Unauthorized Activities at Work
If the worker is found to have been engaged in unauthorized activities while at work, it could lead to the denial of their workers’ comp claim.
For example, if a worker injures themselves while partaking in activities that are prohibited by their employer or not typically associated with the job at hand, then the chances of their claim being accepted decrease significantly.
Employers may also deny claims based on evidence that shows that the injury was self-inflicted or caused by reckless behavior.
What to Do if Your Workers’ Comp Claim is Denied
A workers’ compensation attorney can provide invaluable assistance if your workers’ comp claim has been denied. They can help you understand the applicable laws and explain the legal process to you.
Attorneys who specialize in this area of law also have a keen understanding of the strategies and techniques necessary to successfully litigate against a denied claim. They can work with you to identify any legal issues that are preventing you from receiving the benefits that you deserve.
Additionally, they will be able to form a strong argument to support your case in court, as well as navigate complex paperwork that may be required for filing a claim against the workers’ compensation insurance carrier.
With their expertise and knowledge, a workers’ compensation attorney can help ensure that your rights are protected and successfully fight for the benefits that you deserve.
Kotlar, Hernandez & Cohen: New Jersey Workers’ Compensation Lawyers
Kotlar, Hernandez & Cohen – The People First Lawyers have been helping injured workers with their New Jersey workers’ comp claims since 1995. Our law firm works tirelessly for our clients to ensure you receive medical treatment, financial compensation, and justice, regardless of an adjuster or insurance carrier’s claim denials. With four Board-Certified Workers’ Compensation Law attorneys on our team, we are well-equipped to handle your workplace injury claim.
If you’ve been the victim of a work-related injury or occupational disease, or if your workers’ comp claim is denied, please contact our office to schedule a free consultation or call us 24/7 at (856) 751-7676.
Justin Cohen, Partner
Justin is a partner at Kotlar, Hernandez & Cohen and a Board-Certified Workers’ Compensation Attorney. He is believed to be the youngest attorney in New Jersey to receive his Workers’ Compensation Board Certification. His aggressive style and diligent efforts have helped him to recover significant benefits for his clients.
