Given that a workplace accident can knock you out of work and force you to seek costly medical care, you need money after being injured on the job.
A workers’ compensation claim might provide the relief that you need, but only if you’re successful on your claim. You see, pursuing a workers’ compensation claim isn’t always as easy as it seems.
Your employer and their insurance company aren’t just going to hand you the money that you need. Instead, they have an interest in protecting their own financial wellbeing, which means they’ll probably look for ways to minimize or outright deny your claim.
Therefore, as you head into the workers’ compensation system, you need an understanding of the justifications relied upon by insurance companies to deny these claims. That way you’ll be better positioned to build the effective workers’ compensation case you need.
Why do insurance companies deny workers’ compensation claims?
Your risk of denial is going to depend on the unique circumstances of your case. That said, here are some common reasons insurance companies use to deny workers’ compensation claims:
- A pre-existing medical condition: The insurance company isn’t going to want to pay you for an injury or medical condition that wasn’t brought about by your work duties. So, they might try to pin your harm on your pre-existing condition, arguing that your work didn’t exacerbate it at all.
- The injury was suffered outside of work: The insurance company will do everything it can to try to show that your injuries were suffered outside of work, including scouring your social media for indications of an injury that occurred prior to the workplace accident in question.
- Lack of medical follow up: If you’re injured at work, you need to seek medical care. If you don’t, then the insurance company is going to claim that your injuries aren’t as severe as you claim them to be and that there’s no indication that your injuries prevent you from working.
- The injury was caused by your own negligence: Your employer and their insurance company will also argue that your workplace injuries were caused by your own horseplay or your own negligence. If they’re successful, then your claim will be denied. This is why witness testimony can be crucial to your claim.
- You failed to notify your employer: There are strict timelines in place when it comes to reporting your injury. If you fail to meet the deadline, then you could be cut off from seeking the benefits you need.
- Drugs or alcohol were in play: Intoxication leading up to the workplace accident is sure to be the death knell for your workers’ compensation case. This is why employees are often asked to drug screen after a serious accident.
There may be other justifications that the insurance company uses to deny your claim. Just make sure you fully vet your circumstances so that you can lay out the best arguments possible to counter these potential reasons for claim denial.
Fight to secure the workers’ compensation benefits you need
Workers’ compensation benefits are key to your recovery. You need to aggressively fight to secure the lifeline available in your time of need.
So, gather documentary and witness evidence, gain an understanding of the workers’ compensation system, and be ready to advocate for yourself in the face of a confrontational insurance company.
By being prepared and anticipating the other side’s arguments, you’ll hopefully be positioned for the outcome that you want.
