Apr 7, 2017
Common Reasons Why Workers’ Comp Claims Are Denied
It isn’t uncommon for legitimate workers’ compensation claims to be denied by insurance companies. Employees may be forced to fight for their claim to ensure that they receive the compensation they deserve for their injuries. But why do these claims get denied?
Workers’ compensation claims can be denied because:
- The injury wasn’t witnessed.
- The injury wasn’t immediately reported.
- There was a discrepancy between initial medical records and your accident report.
- The initial medical records indicate that there were illegal drugs present in your system.
- The claim was filed after you were terminated from the company or laid off.
- You refused to provide a recorded statement to the insurance company or sign a medical authorization form.
It can be difficult to prove a claim for an injury that wasn’t witnessed. You can’t change that there wasn’t a witness when you were injured, but you can immediately report your injury to your supervisor and coworkers, and be certain to tell each person the exact same thing. If each person’s account is the same, it can strengthen your claim.
Waiting to Report Your Injury
Failing to immediately report your injury can lead insurance companies to believe that you weren’t really injured. You also have a short period of time to report your injury, often only a period of a few days. If you feel your injury could possibly cause you more harm later, you should inform your supervisor of the injury and fill out an accident report.
Discrepancies in Your Records
Your initial medical records will indicate the extent of your injuries to the insurance company. If you report different accident circumstances to your doctor than you did to your employer, your claim may be denied. Be sure to be consistent when giving your report to your doctor, supervisor, coworkers, the personnel office, or other individuals.
If the initial medical records indicate that there were illegal drugs present in your system, your claim is likely to be denied. The insurance company will probably claim that you were impaired and that your accident is due to your own negligence.
Claims after Termination or Lay Off
You are unable to claim workers compensation after you have been fired from a company or have been laid off from the company. Don’t wait to report your injury and file a claim. If you are laid off or terminated before you file your claim, the insurance company may feel that your claim is simply a revenge claim.
Refusing Medical Authorization or Recorded Statements
The insurance company will usually need to see your medical records when you file a claim. They will probably request that you sign a medical authorization that will allow the insurance company to request your medical records and bills directly from your healthcare provider. You have no obligation to sign a release, so long as you send the records and bills related to your accident to the insurance company. Insurance companies may still deny the claim if they feel that the records are an inaccurate representation of your injuries. They may also try to use a medical authorization to look into your previous medical history for evidence that can be used against you.
You also are under no legal obligation to allow your statement to be recorded by the insurance company. They may refuse your claim if you do not comply, however. Consult an experienced workers’ compensation attorney before allowing your statement to be recorded. Insurance companies can use either your recorded statement or your refusal to provide one against you, so it is important to seek advice from a lawyer.
Facing insurance companies on your own is a challenge. A qualified workers’ compensation attorney can help you file your claim or can help you fight for your claim if it is denied. You may need assistance gathering evidence and information about your accident, or you may need help negotiating with insurance companies. An experienced lawyer can protect you from the insurance company’s inappropriate requests and can help you guard your claim.
Hansford McDaniel LLC is dedicated to advocating for injured employees. Our team of Atlanta workers’ compensation attorneys can help you develop and defend your claim. We strive to help our clients with accessible, caring legal representation. Contact our firm to request a free case evaluation by calling (770) 741-2825.