Reasons Your Workmans Comp Claim Can Be Denied

When you receive a notice stating workmans comp claim denied, you may be very frustrated and concerned. After all, you've probably suffered a serious injury at work. You may have been out of work for a while and the bills may be mounting. You may be in pain and facing doctors bills and counting on the workers comp benefits to take care of all the expenses associated with your accident. So, naturally, the first thing that you will ask when you find a workmans comp claim denied is, why was it denied and what can I do to fix the problem.

Why A Workmans Comp Claim May Be Denied

Workmans compensation is designed to be a pretty comprehensive system. While it means that employees can't sue their employers for injury at work, it also means that employees are supposed to recover in more cases. For example, an employer need not be negligent for an employee to get workers comp benefits (unlike with a standard personal injury case). In addition, the benefits are essentially defined or pre-set by law, guaranteeing the payment of medical bills and a set amount of disability benefits based on either the nature of your injuries or on a rating of how serious your injuries are.

Since the system is meant to include almost all workers and make sure workers are compensated, what are the reasons why your claim may be denied?

Insufficient evidence you actually suffered an injury: Did you not provide enough medical data or expert opinion to prove that you are actually hurt
Filing after the deadline: In most states, there is a time limit in which you can file a workers comp claim. The limits vary by state, but filing too late or letting your employer know of your injury too late can result in your claim being denied.
Questions about whether the injury arose out of work duties: While you don't have to physically be at work when you are hurt, your injury does have to be directly caused by your work. If you got hurt out of the office or in an unconventional manner, you may need to do more to prove that it really is a work related injury
An express violation of company policy or evidence of intoxication: If you came drunk to work and got hurt, the reality is your workers comp claim is not going to be accepted.

Getting Help

When your workers comp claim is denied, the best thing to do is to consult with an experienced workers comp attorney who can provide you with specific details on how to file an appeal. Appealing your denial is the best chance you have to get your benefits and with the help of a qualified attorney, you are more likely to be successful at that appeal.

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