If you are injured while on the job, you have the legal right to claim Workers’ Compensation benefits. However, the Workers’ Comp system is quite complex, which means your claim may be denied for any number of reasons. You have the legal right to appeal the decision if that happens to you. However, it’s helpful to know why you might be denied Workers’ Compensation benefits. Here are five of the most common reasons for your claim to be denied.
1. Your Injury Didn’t Occur at Work
One of the most common reasons for a Workers’ Compensation claim being denied is that the injury you sustained didn’t happen while you were at work.
- A requirement for claiming benefits is that you must have sustained the injury during the “course of employment” and while you were actually working.
- If the injury occurred outside of work and you were not doing any work for your employer, your claim can be denied.
However, it’s important to note that you don’t need to be on the premises at your workplace to be injured while working. For example, if you are an appliance repair person and you were injured after twisting your ankle on the customer’s front walk, you can claim that as being injured on the job.
2. You Did Not Notify Your Employer of Your Injury Within Required Timeframe
Workers’ Compensation claims must be filed with your employer within a designated time limit. In general, you should inform your employer immediately if you are injured. Waiting to report your injury can work against you in a few ways.
- Your employer will be unable to investigate the accident.
- Your employer and the insurance company can deny that you were hurt on the job.
The sooner you report your injury the better, and you will reduce the chances of your claim being denied.
3. It was a Pre-Existing Injury
If you have a pre-existing injury, especially if it is the same or similar to your current injury you sustained while on the job, your Workers’ Comp claim may be denied. This is especially true if the injury is in the exact same body part as your pre-existing injury. The insurance company will dig into your history and accuse you of fabricating your claim.
Keep in mind that having a pre-existing injury doesn’t automatically mean you will be ineligible for Workers’ Compensation benefits. Some states will still cover you if your pre-existing injury is made worse by an accident you sustain at work.
4. You Failed to Receive Medical Treatment
Another common reason why your Workers’ Comp claim may be denied is that you failed to receive medical treatment. If you are legitimately injured, seeing a doctor or going to the ER should be one of the first things you do.
- With a Workers’ Comp claim, you also need medical records to prove you were injured.
- The insurance company can claim that you faked injury to receive benefits.
- In addition, if you don’t get medical treatment and are either laid off or fired from your place of employment, the insurance company can debate that you filed your Workers’ Compensation claim as a means of revenge against your former employer.
5. You Were Intoxicated at the Time of Injury
In the majority of states, your Workers’ Comp claim can automatically be denied if you were intoxicated at the time of your injury and that was at least partly why you were injured. Your employer has a right to request that you be tested for the presence of alcohol or drugs for this reason. If you seek medical attention immediately after the accident and drugs or alcohol is found in your system, your claim can be denied.
If you are injured on the job and need to file for Workers’ Compensation benefits, it’s best to have a skilled work injury lawyer New York relies on, on your side. This is your best bet at being approved for benefits while you recuperate from your injury.
Thanks to our friends and contributors from Polsky, Shouldice & Rosen P.C. for their insight into workers compensation claims denial.