An injury at the workplace can leave you unable to work for days, weeks, or even months after the accident. Fortunately, certain protections, including workers’ compensation benefits, are established just for situations like these. Workers’ compensation covers the medical costs of your injury, lost wages, and lost earning capacity. However, it isn’t as simple as filing a claim to receive these benefits. When filing a workers’ compensation claim, you must meet and prove specific requirements before receiving any benefits.
In the state of Indiana, employers are required by law to carry workers’ compensation insurance, ensuring that any injured worker receives the necessary medical treatment and wage benefits during their recovery. However, despite the existence of the workers’ compensation system, claim denials can and do occur, leaving injured workers upset and confused.
Five Common Reasons Why Workers’ Compensation Claims Get Denied
In many cases, workers’ compensation claims are not properly filed or do not meet certain requirements. Understanding the common reasons for claim denials can help employees take appropriate steps to protect their rights. Five common reasons why workers’ compensation is denied are:
1. Failure to Report the Injury in a Timely Manner
In most states, if you suffered a work-related injury, you must notify your employer within 30 days of the accident. If you file a late report of the accident and injury or submit the application for compensation past the deadline, the insurance company can refuse or reduce your payment.
2. Lack of Medical Evidence
To qualify for workers’ compensation benefits, providing a qualified medical exam supporting the connection between the injury and the work environment is vital. Accurate and detailed medical evidence is instrumental in a successful workers’ compensation claim. Evidence that supports a claim includes medical records, treatment plans, and an authorized healthcare provider’s opinion. If any of this information is deemed insufficient or does not relate back to the workplace, the claim can be denied for lack of supporting documentation.
3. Failure to Follow the Employer’s Policies
If you are injured at the workplace but do not follow the employer’s policies in preventing an injury, it may lead to a claim denial. In such cases, it may be determined that the injury is your fault, even if it happened while you were working. Examples of denials would include horseplay during the workday, negligence on your part, or if you were under the influence of alcohol or another substance.
4. There Was a Pre-Existing Injury
If you already had an injury or related medical condition before your accident at work, insurance companies may deny your claim. Workers’ compensation benefits are intended to cover injuries and illnesses directly related to job duties and work environments. However, if the aggravation of a pre-existing condition is caused by work, you may still be eligible for workers’ compensation benefits.
5. Employer Denies You Were Working
The employer will be the first to investigate your injury claim and establish if you were working at the time of the accident. Your injury may have happened while on a lunch break or commute and not actually while you were “on the clock” for the work day. If this happens, it is the employee’s responsibility to prove they were working at the time of the injury through a timecard, paystub, or witness statements from a coworker.
This isn’t a comprehensive list of reasons why workers’ compensation is denied. We’ve addressed a few other reasons before.
Your Claim is Denied. Now What Do You Do?
It can be disheartening to be denied your workers’ compensation claim, but you are not out of options. Once you receive a letter stating that your workers’ compensation claim has been denied, you can file an appeal against it within a certain timeframe. The letter will likely explain your options on how to file such an appeal, but this process can be difficult and cumbersome. You will need to present evidence and arguments to support your claim, and this can be challenging when the insurance company is using their own high-powered attorney.
With the help of a qualified attorney who understands the ins and outs of workers’ compensation claims, you stand a better chance of winning your appeal. An attorney with the right expertise can help you navigate the complex appeals process. The attorney can also help you bring together the relevant evidence and argue your case in a more coherent manner in front of an administrative judge, and wait for their judgment on whether you will receive your benefits.
Summary
If you or someone you love was injured in an incident at the workplace, contact our injury law firm today. Our attorneys will help ensure that you receive just compensation following your injury and that you also receive the workers’ compensation coverage that you are guaranteed.
The lawyers of Golitko & Daly will help you with the litigation process and provide you with the peace of mind necessary to recover and move forward. To schedule a free consultation, call us at 317-566-9600 (Indianapolis), 765-865-9300 (Kokomo), or 812-566-2600 (Bloomington), or complete our online inquiry form to schedule an appointment with one of our health professional attorneys to review your case. We hope to hear from you if you were harmed through medical treatments or neglect. We have offices in Indianapolis, Kokomo, and Bloomington to serve you.