When Can Workers’ Compensation Claims Be Legitimately Denied?

Your employer’s insurance company is not your friend. They will try to deny your claim. They will try to reduce the amount of benefits that are due to you. They will try to force you back to work as quickly as they can. There are some reasons for denial that are legitimate, but many of the reasons employers deny claims can be challenged. Never assume your employer’s denial has merit. Call our experienced Kansas and Missouri workers’ compensation lawyers to discuss your claim and your right to seek work injury benefits.

 

Employers may attempt a number of ways to deny your workers’ compensation claim, but our attorneys know how to fight for your rights.

That your injuries or illness were due to pre-existing conditions

Employers are liable for all your medical bills and your proportional share of lost wages, if your injuries were caused by a current workplace accident or an illness that you developed through work. If you developed your injuries prior to the accident or before starting work, you generally are not entitled to claim benefits – with notable exceptions.

If a workplace accident aggravated or worsened your prior injuries, then you can claim benefits, including payment for medical treatments and lost wages. Some adjustments may be required to reflect the severity of the new injury and the old injury.

Employers are especially likely to question whether these injuries pre-existed your current pain: carpal tunnel syndrome, repetitive stress injuries, neck pain, back pain, and soft tissue injuries. Our Kanas City workers’ compensation lawyers fight to show your new injuries are either unrelated to your prior injuries or that a recent accident made your health so bad that you now can’t work and/or need additional care to treat the injuries.

That you did not give timely notice to your employer about your accident

There are two time-limited requirements in workers’ compensation cases.

• You must notify your employer promptly that you had a workplace accident. This time limit is fairly short. Generally, you must give notice to a supervisor, manager, or the employer. As a rule, workers should notify their employer as quickly as possible. In Missouri, the time limit to give notice is 30 days. The time limit in Kanas is generally 20 calendar days – though some exceptions may apply. Our attorneys can explain in more detail.
• You must file your claim for benefits before your local statute of limitation expires.

Our work injury lawyers explain the time limits and exceptions that apply depending on the state where you work. We also may assert that you did give proper notice, or that the notice should be extended because of the severity of your injuries, or because you weren’t aware of your injuries until much later after the accident occurred. In Missouri, if the employer had actual knowledge of the accident (even though you did not provide written notice), you may still be eligible to file your claim.

That you are ready to return to work when you’re not

Employees have the right to receive medical evaluations and treatments for their injuries. Workers normally meet with doctors selected by their employer, though there may be grounds for requesting the right to choose your own doctor. After a certain amount of time, most employers will challenge whether additional medical treatment is helping you. They may argue that you are ready to return to work but are extending your treatments to extend your claim. Employers may request that you undergo an independent medical exam (IME).

An IME means that another doctor evaluates you for the specific purposes of deciding the severity of your injuries and determining whether additional medical care is likely to improve your injuries. The IME is not the final word on your health condition. Your treating physician has the right to review the report of the IME.

Your doctor can explain, if necessary, why the IME’s analysis has flaws and doesn’t fully reflect the type of care you need. Our lawyers will demonstrate what happens at the IME, what questions you should be prepared to answer, and what you should look for (such as which tests the IME gives you). We often contest the IME’s findings, who only sees you one time and who often only works for employers and not for workers.

That your injury was not work-related

Employers and insurance companies often argue that your accident did not occur at your job so you can’t collect benefits. That analysis is often not correct. If you are injured away from the worksite, you may be able to collect benefits on the grounds you were still working within the scope of your employment. For example, salespeople who are hurt while visiting clients can claim workers’ compensation benefits if they are injured in a car crash on the way to visit the client. Telecommuters who trip over a rug can claim benefits if they were on the clock while they were working.

We contest many other challenges to your work status, too. For example, if you are injured in a slip-and-fall accident while eating lunch at the company cafeteria, you should be able to claim benefits.

What if I am intoxicated or under the influence of drugs at the time of my accident?

Workers generally cannot voluntarily become so impaired due to drugs or alcohol that they cannot do their job. If you have a positive drug test or blood alcohol test, your employer will likely challenge your right to benefits.

However, the positive news is that there are defenses when your claim is denied. Our attorneys may be able to show that the accident would have occurred despite your impairment; that anyone, even a sober person, would have suffered injury. We have the right to contest the validity of a chemical test. We may also assert that your inebriation was expected because it was part of social activity at work where everyone was drinking, including the employer. We may argue that the drugs were approved medication of which your employer had previous knowledge.

How else might insurance companies might try to deny my Kansas City workers’ compensation claim?

Insurance companies will often assert other defenses, such as:

• You failed to see your doctors or follow their treatment.
• You failed to look for work when you became healthy.
• You refused light-duty work when your doctor said you could work with restrictions.
• You are an independent contractor.
• Your injuries were due to violent acts that you caused.
• You failed to give your medical providers correct information.

It’s critical that you speak with an experienced workers’ compensation lawyer as soon as possible. At Kansas City Accident Injury Attorneys, we’ll explain your rights, advise you what challenges to expect, and fight to assert your full claim to benefits. We’ve helped numerous Missouri and Kansas workers obtain the just recoveries they deserve. We help workers obtain the medical care they need, obtain temporary work loss benefits, and permanent disability benefits. To review your rights, call us at 816-471-5111 or use our contact form to schedule your free consultation.