Why Was My Workers Comp Claim Denied?
Workers compensation claims are generally made for one of the following three reasons: an injury that occurs while at work, an illness caused by an occupation such as asbestos exposure, or a long term trauma caused by the job such as carpal tunnel. Most workers who file such claims have legitimate concerns and deserve the compensation, but, unfortunately, there are a number of reasons that a workers compensation claim might be denied.
The most common reason for workers compensation denial is an employer dispute. An employer should have insurance for workers compensation situations but regular claims will raise their premiums which is why employers often dispute them. If an employer believes that a worker is filing a claim for an accident that has not occurred at work or an illness that they do not believe was caused by the job then they can dispute the claim, which often leads to denial.
Unapproved Medical Treatment
Many workers compensation claims are denied due to unapproved medical treatment. For instance, in most cases, an employer has the right to select and/or approve the medical provider and if an employee goes to a different provider without approval, the claim can be denied. In addition, if an employee does not seek medical treatment at all then their workers compensation claim is likely to be denied as it may not have reached the point of being considered “medically justified” if the employee saw no reason to seek help.
Employee At Fault
Finally, workers compensation claims are denied when the employee is in some way at fault for the accident or injury. For instance, an employee who was intoxicated would likely not be granted a claim. In addition, some pre-existing conditions that are aggravated by the job are the responsibility of the employee and not the employer which can lead to claim denial. Any types of horseplay may also mean that a claim will be denied since workers compensation must be while the worker is completing something productive for the employer.
In most cases, workers compensation denials can be appealed with the help of an attorney. It is important to note any potential deadlines within the denial letter and contact the employer as well as the insurance carrier for further information before appealing. If you find yourself in a situation requiring workers compensation, an attorney can help you avoid the aforementioned common reasons for claim denial detailed above.