Why was My Workers’ Compensation Claim Denied?

Workplace injuries can cause emotional stress, embarrassment, and fear. Workers’ Compensation benefits help to ease some of the financial concerns. When a Workers’ Compensation claim is accepted, the injured worker receives a portion of wages for the duration of the claim and compensation for medical treatments associated with the injury.

Yet, what happens when a worker files a claim only to have it denied? The good news is that workers have the right to appeal the decision. Nevertheless, anyone who has been denied will want to work with a Workers’ Compensation lawyer. Legal professionals who practice in the area of Workers’ Compensation understand that an initial denial can occur, even under legitimate circumstances. Consequently, they are ready to help clients identify and overcome the following reasons that insurers deny claims:

Key Deadlines

Many workers do not realize that as soon as they get hurt, the clock starts ticking to file a claim. The first deadline an injured employee must meet is to tell their employer about the injury as the time limit can vary by state. Usually, the faster a worker says something, the better. That way, the worker has established the date, time, and circumstances surrounding the injury, making it harder for the employer to say the event never happened.

After a worker reports an injury, the worker will usually be asked to fill out an incident report. The incident report is used by the employer to start an investigation into why, when, and how the accident happened. Many employees do not realize that handing in an incident report is not the same as filing a claim; a claim involves different paperwork and must be submitted within 30 to 90 days after the accident.

The longer an employee waits to retain legal counsel or try to appeal the claim themselves, the greater the chance of exceeding the accepted time limit for appeals. Missing just one of these deadlines could cause a strong case to be immediately denied.

Seek Medical Attention

It is not good enough for an insurance company to hear about an injury. Workers’ Compensation adjusters want proof that the injury occurred, that it happened while the employee was performing their work duties, and that treatment was necessary. After telling an employer about an accident, a worker might be sent to a physician picked by the Workers’ Compensation provider. The worker should agree to see the physician but also retain the right to seek out a different doctor after the initial assessment.

Too often, medical personnel paid for by employers and Workers’ Compensation companies underplay injuries and the treatment needed. Nevertheless, seeking any type of medical attention is wise. Without a doctor’s diagnosis, a Workers’ Compensation adjuster will assume that the injury was not serious, and the worker is faking. If an employee waits days after the injury, the adjuster may argue that the injury took place outside of work.

Irresponsible Actions

Employees sometimes get hurt because they were fooling around on a job site. In that case, a Workers’ Compensation adjuster will find out quickly because the employer will share the information from the accident report. Co-workers will usually tell the truth, which means that an employee who was injured because of his or her own misdeeds should expect a denial letter in the mail. Employees under the influence of drugs or alcohol at the time of the accident will not likely receive any benefits.

Pre-Existing Conditions

Plenty of Workers’ Compensation claims are denied because the insurance adjuster makes it appear as if the injury was part of a pre-existing condition. For instance, if a worker came into the company with a back problem and later filed a claim for a herniated disc injury, the Workers’ Compensation provider may say that the injury pre-dated employment. This can be a difficult challenge to beat, especially for workers who are trying to file an appeal on their own. Those working with legal professionals typically have a stronger chance of winning an appeal if this is the reason for the denial. Lawyers know how to build and present a case to show that even though the worker had a pre-existing condition, the new problem was directly linked to their work duties.

Employer Says the Injury Never Occurred

Workers’ Compensation may be a built-in benefit of working for a company, but some companies would rather fight against an injury claim than potentially have their Workers’ Compensation insurance premiums rise due to excessive numbers of payouts. Consequently, employers will sometimes tell adjusters that, after investigation, they determined the accident did not occur at the workplace. This may be devastating to hear, particularly if an employee was seriously injured and will require months of therapy and treatments to get back or close to normal functioning. Having an attorney can help prove that the employer is not telling the truth.

The Injury is Not Covered

What happens if a worker suffers a mental issue, such as extreme depression or post-traumatic stress disorder directly related to work? Unfortunately, many states do not recognize the viability of mental health-related claims. That does not mean that it is never worth fighting these types of denials. Plus, the emotional injury may have physical manifestations that could be considered by an adjuster.

Should Injured Workers Contact Lawyers Immediately?

It is not necessary for all injured workers to get in touch with a Workers’ Compensation lawyer. At the same time, if the injury is serious, the employee suspects the claim may be difficult to prove, or will be challenged by the employer, the employee may want to contact a lawyer.

Mount Laurel Workers’ Compensation Lawyers at Kotlar, Hernandez & Cohen, LLC Help Injured Workers Appeal Workers’ Compensation Denials

If your Workers’ Compensation claim was denied, contact a Mount Laurel Workers’ Compensation lawyer at Kotlar, Hernandez & Cohen, LLC about your options. We will review your case and obtain the benefits you deserve. Located in Mount Laurel, Cherry Hill, Trenton, and Vineland, New Jersey, as well as Trevose, Pennsylvania, we serve clients throughout the surrounding areas. Call us at 856-751-7676 or submit an online form for a free consultation today.

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