Top 10 Reasons Your Workers’ Compensation Claim Could be Denied

The vast majority of Florida employers are required to carry workers’ compensation coverage.  Unfortunately, just because your employer is covered, that doesn’t mean your claim won’t be denied.

Filing for workers’ comp is not as easy as you may think.  By knowing why claims are denied, you may have a chance at avoiding a denial and get the benefits you need.

Why Workers’ Compensation Claims are Denied

1.  The injury didn’t happen on the job. If you’re injured at your job site, it’s usually pretty clear that you have a workers’ comp claim. However, if you are injured off the job site while doing something for work, the insurance company may try to deny your claim. Claims adjusters may try to work with your employer to prove that you were doing non-work-related activities when you got hurt.

2.  You have reached MMI. When your doctor places you at maximum medical improvement level or MMI, your employer and/or the insurance company may try to give you the impression that your claim is over and you are not entitled to any more benefits. Not true. Although you may not be entitled to further financial benefits, you can still go back to the doctor after MMI.

3.  You went to the doctor on your own. If you go to a doctor that has not been officially authorized by workers’ comp, either because you wanted to or because your employer told you to, workers’ comp may try to weasel out of your claim by saying your injuries are not work related. Their job will be made easier if your doctor doesn’t specifically note the cause and location of your accident in your medical records.

4.  No one documents that it was a work injury. Even though you report your claim to your employer, that doesn’t mean your employer will report your claim to the insurance company. When you report your claim, make sure you get written confirmation from your employer and demand to know the insurance adjuster that has been assigned to your claim.

5.  You were intoxicated. If you were working while intoxicated, you will not be eligible for benefits. However, there are specific steps that your employer must take to prove you were intoxicated at the time of your accident in order to succeed at denying your claim.

6.  You were on your way to or from work. If you were injured on your way to work or going home, those injuries are not usually covered by workers’ compensation insurance. There are certain exceptions, however.

7.  You didn’t notify your employer of the injury soon enough. Workers compensation claims are strict. If you do not file your claim or notify your employer within the required time, then you could have your claim denied regardless if you have a valid injury.

8.  You never sought medical treatment. Oftentimes, claims are denied because the injured worker hopes the injury will heal on its own and does not report the claim or seek medical treatment. If weeks or months go by and you do not report your claim, it will be much easier for the insurance company to deny it.

9.  You are filing for a condition you already had. If you have a pre-existing condition and it wasn’t aggravated by your job, you will be denied benefits.

10.  You didn’t hire a workers compensation attorney. People often think that hiring a lawyer will make their employer and/or the insurance company angry and cause them to treat you even more unfairly. Not true. Having an attorney will make your employer/insurance company less likely to mess with you because an attorney will know the games they are likely to play.

Let the Law Office of Christopher J. Annis, LLC help you with your workers compensation claims. Call us today for a free consultation.

 

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