When Can a Workers Compensation Claim Be Denied?

When Can a Workers Compensation Claim Be Denied? 

Workers compensation insurance offered through employers is designed to cover employees who are injured on the job. It can help with a variety of expenses related to a workplace injury, from emergency medical bills to wage replacement. Unfortunately, not all workers compensation claims will be approved. 

There are some cases where a workers compensation claim may be denied. This generally happens when the injury is not covered under the employer’s policy or other requirements of the claim are not met. It is important to understand the limits of your employer’s workers compensation policy and keep track of every aspect of an accident. 

Lack of Documentation 

One of the major reasons a workers compensation claim may be denied is a lack of documentation. If no one is around to see the injury, you may have a hard time convincing an insurer that the injury occurred at work or related to work practices. Keep in mind that not all injuries that occur on your employer’s property may be covered. If you are injured, make sure to speak with those who witnessed the injury and have them speak on your behalf to your employer and, if necessary, the insurer. 

If possible, write down the incident or take pictures of the area. If the property has cameras, make sure your employer checks the camera’s history for the incident. 

Missing the Time Limit 

Many workers compensation policies have an expected time limit in which an employee should file a workers compensation claim. If an employee waits too long to report an injury or file a claim, the insurer may suspect that the injury was not severe enough to need compensation if it was not reported immediately. Some states also have laws requiring employees to report work related injuries within a certain span of time, such as a week (seven days). If you wait too long to report an injury or file a claim, you could find your claim denied. 

Mismatching Information 

Even if you have all of the information about a workplace injury as well as witness testimonies, you aren’t completely protected from a denied claim. In some cases, statements and proof may be inconsistent, leading to a denied workers compensation claim. This is especially true if your accident report and medical records do not match up. For example, say an employee claims they trip and fall on their knee while carrying a heavy box at work. When they seek medical attention, they tell their doctor that they twisted their ankle. A claims adjuster from the insurer will investigate the claim as well as the initial medical report. If they find any inconsistencies, a workers compensation claim could be denied based on dishonesty. It is crucial to always be honest with your supervisors and doctors after a workplace injury. 

Not Seeking Medical Help 

While there is a time limit to reporting an injury, there is also an expectation for seeking medical attention after a workplace injury. Most workers compensation policies will require you to seek medical attention immediately following a workplace injury. Waiting too long may result in a denied claim, as the insurer will believe that the injury was not severe enough for medical attention. Also keep in mind that many workers compensation policies have a list of approved medical providers. If you do not see a medical provider that is approved, even if you seek immediate medical attention, your claim could be denied. If you have a preferred medical provider, make sure they are covered under your employer’s workers compensation policy. 

Accidents Not Covered 

Sometimes, the nature of the accident itself will be the difference between an approved claim and a denied claim. Accidents will not be covered if the injury occurs while: 

Refusal to Speak with the Insurance Company 

Insurance providers will generally want to hear from the employee directly or otherwise have them sign certain medical authorizations. Refusing to do so is not legally required, but the insurer may state that this choice prevents the start of workers compensation benefits. Employees may be able to get around signing certain medical authorizations by getting their own medical records and sending them to the insurer of their own accord.