Why Was My Workers’ Compensation Claim Denied?

Like other kinds of insurance claims, carriers will look for any possible reason to deny a request for workers’ compensation benefits. After all, their ultimate goal is to protect their bottom line.

That doesn’t necessarily mean, however, that all their denials are warranted. If you were hurt on the job but your claim was refused, you may still be entitled to benefits; you’ll just have to go through other legal channels to pursue them.

Let’s take a look at some of the most common reasons why workers’ compensation claims are denied (and when such denials may not actually be fair):

1. Missing an Applicable Deadline

Upon getting hurt on the job, you have 30 days to notify your employer. A version of this deadline also applies to occupational illnesses that develop over time. You must notify your employer of any such conditions within 30 days of discovering their link to your job duties.

It’s imperative that you submit notice of your injury or illness in writing, even if your supervisor witnessed the accident or is already aware of your condition. Failing to meet this deadline is one of the most common reasons why workers’ compensation claims are ultimately denied. 

2. Taking Action After Leaving the Job in Question

Generally speaking, a company’s workers’ compensation insurance only covers those who are currently employed with them. As such, a denial is all but inevitable if you end up filing your claim after leaving your job.

If there happens to be a good reason for the complicated timeline, though, it may still be possible to secure benefits. For example, if you had already notified your employer that you were leaving and you were hurt during your last week or two on the job, you should still be able to pursue compensation through them. As long as you were technically employed by them at the time of injury, their coverage should apply. 

3. The Injury Does Not Appear to Be Work-Related

In order to be eligible for workers’ compensation benefits, you must have been hurt while on the clock, and you must have been acting within the scope of your employment at the time. If you cannot prove as much, the insurer will likely deny your claim.

Evidence that may help prove your injury is indeed work-related includes:

• The incident report pertaining to the accident in question;
• Surveillance footage;
• Statements from eyewitnesses;
• Photographs of the hazard that caused the accident;
• Medical records; and/or
• Testimony from relevant specialists who can link your condition to your job duties. 

Speak with a West Palm Beach Workers’ Compensation Attorney

For help with your workers’ compensation claim, turn to Donaldson & Weston. Our team is equipped to go up against even the largest insurers around the country, and we’re not afraid to take cases all the way to court if the prove uncooperative. To schedule your free initial consultation with a workers’ compensation lawyer in West Palm Beach, fill out our Online Contact Form or call 561-299-3999.