A work-related injury usually involves a workers’ compensation claim, but that does not mean its automatic approval. These are some of the most common reasons for the denial of workers’ compensation claims.
Waiting too Long to Report an Injury
Insurance companies give you 30 days from the time of your injury to report it to your employer, who then submits a claim. If you delay reporting an incident, you risk your claim’s denial by the insurance company, which may view your injuries as minor. Unfortunately, too many people fail to report their injuries to their employers promptly for the following reasons:
- Their symptoms occurred gradually
- Their blame themselves for their injuries
- They don’t realize the severity of their injuries
- They don’t want to cause trouble
By the time employees who delay filing claims realize why it is beneficial to do so, their claims may no longer be valid.
It is in the best interest of an insurance company to pay for the fewest possible claims. Many workers who suffer from chronic conditions, including back problems and asthma, report unsuccessful claims when an insurance provider considers their injury or illness due to a pre-existing condition.
Lack of Medical Documentation
In addition to reporting your injury or illness as soon as possible, it is also necessary to obtain immediate medical care. An insurance company will want to review all of the details surrounding your condition, along with a detailed report from a medical doctor describing how it will affect your job performance. Without this, you can not expect to file a successful claim.
Employers are not necessarily responsible for every injury or illness that an employee sustains while at work. For example, the liability for an accident in which an employee trips and breaks a leg is not due to employer negligence if the employee tripped due to an untied shoelace; however, an employee who slips and breaks a leg due to a cracked floor tile, has a legitimate workers compensation claim.
Injuries Outside of Work Hours
An insurance company can legitimately deny workers’ compensation claims for injuries outside of the work environment or work hours. For example, injuries that happen while walking back to work after a lunch break or on the way to work in the morning do not qualify for workers’ compensation benefits.