8 Common Reasons Workers Comp is Denied

Winter isn’t quite over, and snow and ice are still causing injuries, especially for people trying to work. In fact, according to a recent study, a worker’s compensation claim for snow- or ice-related injury amounts to an average of $48,000. So, it’s no wonder that insurance companies would want to deny a claim for a work injury if they can. Here are some common reasons why you claim could be denied.

No Witnesses

If you’re injured at work, you might face workers comp denial if no one witnessed the accident. The insurance company might not believe that you were injured or that the injury was even a result of work if no one else can corroborate. Employees who report their injuries immediately and who tell the same story to everyone are more likely to be believed.

Unexplained Injury

Many insurance companies will deny a claim if your injury is unexplained. That can mean something as simple as not giving a cause for a fall. You need to be able to say that you tripped over an office rug or a puddle of water was in the middle of the floor in order for the injury to be explained.

Pre-Existing Injury

Oftentimes, a claim can be denied if you have a pre-existing condition or injury. If you have always had a bad back, an insurance company can say that lifting a heavy box didn’t cause a back injury—they’ll say your bad back caused it.

No Medical Documentation

Being hurt at work will require medical documentation. If you don’t see a doctor or go to the emergency room, you won’t be compensated. Insurers also deny claims if you’ve sought medical attention, but they haven’t seen the documents to prove it. Typically, you need to sign a waiver or have documents sent to the insurer. They can also deny a claim if your medical documents don’t match your injury report or even what you’ve told coworkers.

No Injury Report

Many states will require you to fill out an injury report with your employer within 7 days of an accident to receive workers comp. Insurance companies and employers become wary of an employee who claims they were injured much later than an incident occurred or if they don’t tell anyone at work.

Not on the Clock

If you weren’t technically on the clock, if you were traveling for work, or even if you were traveling to or from work when you were injured, your claim could be denied.

Unrelated to Work

If you are injured while you’re at work, you may not be able to collect workers comp if illegal drugs are found in your system. An insurance company will be able to say that the drugs and not a fall on ice caused the injury. You might also be denied if you’re injured while doing something like exercising during your lunch break. The injury would be a result of the exercise and not a work task.

You Took Unnecessary Time Off

Injuries can cause you to miss work; however, an insurance company will deny a claim if you take unnecessary time off. If you don’t require doctor-recommended treatment or rest, but choose to stay home from work anyhow, you may not be eligible for workers comp. Oftentimes, you will require medical documentation stating the amount of work you will miss.

What can you do if your claim is denied?

Unfortunately, insurance companies try to deny claims frequently. If your claim is denied for any reason, you can certainly fight it. The best way to do that is to seek help at a worker’s compensation law firm. A worker’s comp attorney can determine the next best step. A worker’s comp attorney can even deal with the insurance company to get you compensation without going to court. Oftentimes, insurance companies decide to pay a claim as soon as a worker’s comp attorney gets involved. A worker’s comp attorney can also help you if you’re facing wrongful termination.

Work injuries can be especially difficult for people. You won’t only be dealing with pain and missing work—you could be dealing with an insurance company that is unwilling to pay you. Be sure to seek medical attention, file an accident report with your employer, and speak with a workers comp lawyer if your claim is denied.

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