Why a Workers Compensation Claim Would be Denied

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Do not think that filing a workers compensation claim means that benefits are guaranteed. A lot of people with serious and apparent injuries file claims and the only things that they receive are Notices of Denial and disappointment. Like them, you may be asking how and why an injured person can be denied workers compensation.

The first thing that you should realize is that workers compensation benefits are not paid by employers. Benefits are paid by insurance companies. Unfortunately, most of these businesses exist to collect money and they tend to do everything possible to avoid payouts. It’s simply the nature of the business.

To avoid payouts, however, insurance companies look for acceptable reasons to escape liability. Although each state requires workers compensation programs for the protection of employees, each program accepts that some claim denials are valid.

Location Of The Incident

Workers compensation is designed to cover occupational injuries. Claims are often denied because a conclusion is reached that the injury did not occur at work.

Type of Incident

Whether or not the injured party was at fault does not affect whether she can receive compensation. However, what an individual was doing when she was hurt can result in a claim being denied. Benefits are generally not awarded to people who are hurt at work while engaged in non-work related tasks.

Intoxication

Workers compensation claims can be denied if a person is hurt while under the influence of drugs or alcohol. When a person is injured on the job and requires immediate medical treatment, he is likely to be tested for these substances.

Pre-existing Condition

Insurance companies often dig through an injured person’s medical records. One reason that they do this is trying to find evidence that some sign of the injury existed before the incident that the injured party alleges to be responsible ever happened. For example, say a worker claims that a chemical splash caused her to go blind. If the insurance company finds that five years earlier the individual experienced a period of temporary blindness, they may deny the claim on the grounds of a pre-existing condition.

Time Limits

Workers compensation claims must be filed within a certain amount of time. Filing late is grounds may be cited as grounds to deny a claim.

Legal Representation

Do not let a denied workers compensation claim make you feel hopeless. If you receive a Notice of Denial you should contact an experienced attorney and you may still be able to obtain the benefits that you deserve.  

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