5 Reasons Your Workers’ Comp Claim Was Denied

Workers’ Compensation Lawyer Towson, MD 

Employees who have suffered injuries on the job are often shocked to discover that their workers’ compensation claim was denied. The workers’ comp system is quite complicated, and your claim could be turned down for numerous reasons. Fortunately, as a workers’ compensation attorney can tell you, you have the right to appeal a denied claim.

When you appeal this decision, you are well-advised to do so with the help of an experienced workers’ comp lawyer who can help you identify and contest why the insurance company rejected your claim. Here are 5 of the most common reasons your claim was denied.

1. The injury didn’t happen at work

Your injury must have happened while you were performing your job duties to be eligible for workers’ compensation. So, if you were injured while you stepped out to get a sandwich on your lunch break, you are not eligible to make a claim for workers’ compensation benefits. There is a small grey area here. If you were not at the job site, but you were “on the job” at a work event or assignment (such as a company retreat), you may have a claim.

2. You didn’t notify your employer about your injury in the necessary time frame

Specific time limits exist in the workers’ compensation claim process. Once you are injured, you must inform your employer about the injury as soon as you can. If you don’t report your injury as quickly as possible, your employer may not be able to carry out an accident investigation, which is critical for the success of your claim.

Your employer (and their insurance company) may also try to claim you were not really hurt at work. They could argue that you would have reported the issue sooner if you were injured at work. Furthermore, the insurance company may try to claim your injury was not involved with your job duties. They could argue they were the result of a pre-existing condition or something else while you were off the clock.

3. You were under the influence of an intoxicating substance

If drugs, alcohol, or some other intoxicant were involved in your accident, you could not make a claim. Your boss has the right to require that you are tested for alcohol or drugs when you see a doctor for your work-related injury. If test results verify you were under the influence when the accident occurred, your claim will typically be denied.

Although you have to see an approved medical provider to be entitled to compensation, having the help of a workers’ compensation lawyer Towson, MD locals trust will guarantee you the best chance of getting the treatment you require and the benefits you are entitled to.

4. You didn’t get medical treatment (by an approved provider)

If you think your injury is claim worthy, you will need the medical records to prove it. If you did not get medical treatment but later try to file a workers’ comp claim, the insurance company can dispute your injury ever happened, since you don’t have supporting medical records.

Also, under the workers’ comp system, your employer and their insurance company have the right to provide you with an approved list of doctors — these are the only ones you can visit to receive treatment. Make sure an approved provider sees you.

5. You didn’t have a workers’ comp attorney Your claim may also be denied if you don’t have a workers’ comp attorney making sure an accurate and thorough case is presented. A lawyer can guide you through the process and advise you on the steps necessary to give your claim the greatest chance of success. If you have a claim or appeal to file, contact Seigel & Rouhana, LLC a workers’ compensation attorney today.

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