What Can Cause My Workers’ Compensation Claim To Be Denied?

April 27, 2018
By Glauber Berenson Vego

Many Glendale area employees assume they will receive workers’ compensation benefits if they become injured or seriously ill at work. Though their employers’ insurance covers them, there is still the possibility of their workers’ compensation claim being denied. According to the U. S. Bureau of Labor Statistics, “workers’ compensation claims must meet certain criteria before injured workers can receive compensation to cover their medical expenses and lost wages.”

The workers’ compensation system is complex. Sometimes individuals who legitimately deserve workers’ compensation benefits end having their claims denied. Here are some common causes for denial.

Injuries do not qualify – Covered injuries must be a direct cause of a claimant’s work. For example, slipping and falling at work while performing job duties and breaking a leg is a covered incident. However, injuries sustained after slipping and falling after clocking out and leaving the work environment are likely to lead to a denied claim.

Missing information – When seeing a workers’ compensation doctor, injured employees should inform them of all pain and discomfort they experience so they can be documented. That way if other injuries develop as a result of the accident, the physician can include them in the original claim.

Seeing the wrong medical provider – Many people do not enjoy going to the doctor. An injured worker might go and see their personal medical provider for a work accident health assessment and treatment. It is important for anyone who is hurt on the job to see a doctor who is apart of their employer’s worker’s compensation insurance network.

Not reporting injuries in a timely manner – Though some injuries do not show up right after workplace accidents, it is crucial for injured workers to report them. Most employers have specific procedures in place to ensure their employees report their injuries in a timely manner. Failure to abide by the deadline can cause complications with their workers’ compensation claims.

Many injured workers end up having to go through the appeal’s process for approval after having their claims denied. The right legal guidance can help future claimants navigate through the workers’ compensation process.