Reasons Why Your Workers’ Compensation Case Gets Denied
Workplace injuries are typically covered by your employer’s workers’ compensation coverage. In fact, the state requires that an employer carry workers’ compensation insurance coverage when they have a number of workers over a specific threshold.
Therefore, if you are injured at work, you might assume that the injury is covered. You file your claim with workers’ compensation only to find the claim is denied. You do have the right to file a petition for benefits to fight a denial, but there are reasons why the claim might be denied. Before you file your petition for benefits, consult with an attorney and review the common reasons for the denial to see where you might need to make corrections so that you do not waste your time.
Why Are Workers’ Compensation Claims Denied in Sunrise, FL?
If your workers’ compensation claim was denied, you need to understand why it was denied before filing your claiml. The denial letter should specify the reasons for the denial, making it easier to understand what you need to correct. You could be denied for something as simple as not meeting the eligibility requirements or adequately filling out claim paperwork. Other times, you might be denied because the insurer is claiming that you violated your obligations (such as a positive drug screening).
Common reasons claims are denied:
The Injury Was Not Reported in Time
You have a time limit for how long you have to file your injury claim. After you are injured, you must tell your employer right away that you were injured or report it to a supervisor. This provides your employer with the time necessary to conduct an accident investigation, which is crucial for you to succeed with your claim.
Also, your employer must notify the insurer and both work to see if you were legitimately injured at work or making a claim for an injury outside of work. Lastly, it provides you with time to seek medical treatment and present your costs to the workers’ compensation insurance company.
Florida law requires that you report the injury at a maximum of 30 days. If you wait past the 30-day mark, your claim could be denied and your appeal will most likely be denied too.
Your Injury Didn’t Happen at Work
To receive workers’ compensation benefits, your injury must occur during your regular course of employment. You must be performing your job tasks or be on duty at the time of the injury.
For example, if you are driving to work in your personal vehicle and are involved in a car accident, you may not qualify for workers’ compensation because you are not performing job duties during transportation. The only exception to this would be if you are driving a company car and running a company errand on your way to work. In this case, you could receive workers’ compensation.
Insurance companies and even your employer might work hard to try to claim that your injury was not work related. One easy way to combat this is by reporting the injury right away. Reporting it sooner, or having witnesses at work who saw the accident, can help prove that your claim was legitimate.
You Were under the Influence
Workers’ compensation means that you can receive compensation even if you were at fault for your work-related injury. While there is no fault, you can have your legitimate work injury claim denied if you were under the influence at the time.
Workers’ compensation laws would not allow compensation if you were intoxicated by illegal drugs or alcohol. Also, if you make a workers’ compensation claim, expect to be drug or alcohol tested.
You Refused to See an Approved Medical Provider
Workers’ compensation allows your boss and their insurer to pick a list of physicians who are approved to treat you under their policy.
While you must see an approved provider, your attorney can help if you feel that the provider is downplaying your injuries or not treating you fairly. Furthermore, your attorney may be able to get a change of physician if you are not comfortable with your treating doctor.
You Did Not Receive Medical Treatment
You do not go to the doctor for minor injuries. But if you have a severe workplace injury that will keep you away from work, you cannot hesitate to see a physician. You need medical treatment to support your workers’ compensation claim. Otherwise, you open the door for the employer and insurance company to say you faked the injury.
You Failed to File Paperwork by the Deadline
Workers’ compensation has deadlines, and you must file your paperwork within specified amounts of time – even injuries that slowly develop like a workplace illness or carpal tunnel syndrome.
If you fail to file your paperwork on time, you give the insurance company and the employer an opportunity to deny the claim.
You can easily avoid this just by hiring a workers’ compensation attorney. An attorney knows the deadlines for your paperwork and can ensure that all paperwork and supporting documents are filed before the insurance company can deny your case.
Your Injury Was the Result of Roughhousing
Just like being intoxicated, your claim might be denied if you were conducting horseplay and were injured. Practical jokes can also result in a denial if you were performing a practical joke on someone and hurt yourself.
The Injury Is Pre-Existing
If you have a pre-existing illness or injury before starting your job and the job did not exacerbate the illness or injury, you will have your claim denied. You cannot seek workers’ compensation benefits unless your work specifically caused or made the illness worse.
Insurance companies fight very hard to prove injuries or illnesses are pre-existing, and they will try to reject anything that seems as though it is pre-existing.
Your Employer Files a Dispute
Your employer has the right, and typically will exercise that right, to dispute your injury claim. They often do so out of fear that their coverage amounts will increase if workers’ compensation pays out on your claim. Therefore, they may deny the details of your case, argue that you were not at work, and try to do what they can to discredit you.
If you have a workers’ compensation attorney, you will have someone as your advocate looking for evidence and arguing on your behalf to protect you from something similar happening.
Speak with an Attorney Today
If you are seriously injured at work, you have the right to seek compensation. Speak with an attorney from the Law Offices of Law Offices of David M. Benenfeld P.A, today. We can assist you with your workers’ compensation claim – including appeals if your case is denied.