Common reasons why your workers’ compensation claim may be denied
Workers compensation cases can be complex and sometimes, these claims are denied. The reasons for a claim to be denied are manifold; but one should know their rights to appeal the decision. For someone to find out if an appeal should be made, it is necessary to understand why the case was rejected in the first place.
To be eligible for compensation, one should be on duty. For example, if a worker hurts their knee during the work-hours while performing duty, they are likely to receive compensation. Workers compensation does not apply if a person was not at work, was on their way to work or if the injury happened during lunch break. If the injury did not happen at the workplace but happened at a jobsite, or during a work meeting in some other city, one can claim for compensation.
The claim can also be denied if the injury is reported after the time limit of reporting for compensation. It is impossible for an employer to collect evidence of an accident if it is reported later on. This increases the workers compensation cost as some injuries tend to worsen with time when left unnoticed. If there is a delay in the injury report, it is also assumed that the plaintiff is lying and that the injury did not really occur at work.
A person is not entitled to make a claim if he/she was under the influence of alcohol, drugs or other intoxicants. To be entitled for compensation, one should be tested by an approved medical provider. Sometimes, the company provides a list of doctors that should be visited but one should always go to multiple doctors as the company affiliated medical provider might downplay the victim’s injuries.
It is important to have medical reports to support your injury for compensation. Without medical reports, the company will not be liable for settlement. Even if the injury is reported later on, it is necessary to submit the medical reports by an approved doctor.
One should also make sure that all papers and documents needed to make a claim are submitted on time. Insurance companies have certain deadlines after which they do not accept workers compensation claims. Worker’s compensation attorneys are experts in this field. They can guide the victim to avoid any injustice with them or the company and to minimize the complexity of the situation.
If a fight breaks during work and somebody gets hurt, the company is not liable to pay for the compensation. Similarly, if the worker is involved in a practical joke and hurts himself/herself, the company is not supposed to compensate. Such accidents do not cause physical and financial harm to the person involved but they can also lead to other stressful situations between the employer and the employee.
It is rather hard to define a per-existing condition such as a disease, illness or an injury that you had before joining work and if the work has not made it worse in any way, you are not eligible to receive compensation. One of the biggest reasons why a worker’s claim is denied is that he/she did not have a worker’s compensation attorney. Therefore, one should make sure that the case is discussed with an attorney before claiming for compensation.