Reasons Your Claim Might Be Denied, Delayed or Terminated

For employees who are suffering from a serious injury that occurred on the job, a denied, delayed, or terminated worker’s compensation claim can be stressful and confusing. Unfortunately, there are a variety of reasons why worker’s comp insurance can deny a claim for benefits, even if the employee believes they are completely within their rights to receive lost wages and medical expense reimbursement. Below are the most common reasons why worker’s compensation may turn down an application for benefits.

There Were No Witnesses to the Incident

One of the most significant pieces of support evidence for worker’s comp cases is a witness account of the accident or injury. This may be a co-worker who was nearby when the accident occurred, or even a visitor who happened to be on-site at the moment an employee sustained their injury. Typically, the witness must provide a written statement that includes the details of the incident. Lack of suitable witnesses may also cause a delay in processing, as the employee may need to provide other forms of proof.

Report Was Not Filed in a Timely Manner

There is a statute of limitations for reporting workplace injuries and accidents, which can greatly vary from state to state. Employees should report their injuries as soon as possible to avoid going over this statute. This includes submitting a written notification to the employer and filing the worker’s comp form.

Medical Records Are in Conflict With the Report

A worker’s comp claim may be denied, delayed, or terminated altogether if their personal account of the accident differs from the medical records issued by the physician. For example, if an employee states that they suffer from carpal tunnel syndrome and the doctor does not find evidence of this, the worker’s compensation insurance may turn down the claim. Pre-existing medical conditions that contribute to the work-related injury can also lead to claim denials.

Employee Refuses to Sign the Necessary Documentation

Worker’s comp insurance providers may request that employees sign medical release forms and accident statements, as well as other documentation. If an injured worker is uncomfortable with signing any worker’s compensation documentation, they may wish to speak with a trained legal professional who can advise them of their rights and assist them with the process.

The Accident Occurred Under Suspicious Circumstances

If the employee was egregiously negligent when the injury occurred or was under the influence of an illegal substance, the worker’s comp provider may choose to deny the claim. Typically, prohibited substances are detected during the medical exam that takes place after the incident, and are noted in the physician’s medical report.

Workers Comp laws and procedures are complex, and injured workers may find it difficult to complete the process on their own. However, employees can seek the assistance of a lawyer who knows how to navigate the system and potentially reduce the risk of denied, delayed, and terminated claims.