Reasons Why a Workers Compensation Claim Might be Denied

While workers compensation is geared to cover employees who are injured on the job, compensation is not guaranteed. There are a few circumstances in which a workers compensation claim may be denied by the insurance company. It is important to identify these in order to avoid your claim being denied. Common reasons a claim is denied include: 

Lack of Evidence 

One of the most important parts of workers compensation is having a witness. If no one is around to witness the injury, you may have a difficult time convincing others that it occurred (depending on the extent of the injury.) Whether your injury is witnessed or not, it’s crucial to seek help immediately. 

Story Inconsistencies 

When you file a workers compensation claim, your employer’s insurance company will send an claims adjuster to investigate the incident. If there are any inconsistencies within your claim, you could be denied compensation. Whenever recounting the accident that lead to the injury, make sure to keep the story consistent. Stick with general accounts instead of finer details that are more easily forgotten. Your medical records will also reflect the truth of your story. 

Wrong Timing in Filing the Claim 

Claims regarding workers compensation are extremely time sensitive. You must report your injury and seek medical attention immediately. If you delay seeking help, the insurance agency may believe that you are not injured or that your injury is not severe enough for workers compensation benefit. You may be expected to file a claim within the week that it occurs. So even if you have a small injury, it’s important to report it. You never know when a small injury will cause issues later down the road. 

After an accident occurs, it’s best to immediately inform a supervisor, fill out an accident report and seek medical attention. 

Drugs or Alcohol Were Involved 

In each case of workers compensation claims, the employee will be drug tested. If it is discovered that you were under the influence of drugs or alcohol at the time the accident occurred, the claim will likely be denied on the basis that the injury was due to intoxication. Other incidents that are not covered includes if you were playing or doing something outside of your job requirements when the accident occurred. If you’re roughhousing with coworkers and sprain your ankle, a workers compensation claim will likely be denied. This also applies if you start a fight at work or have certain pre-existing conditions. 

Overall, remain consistent in your recount of the injury and be sure to seek medical assistance immediately after a work-related accident.