Workers’ compensation insurance is supposed to be there for you if you are injured on the job. Workers in construction, healthcare, retail, and manufacturing are most often injured on the job and they fully expect that their claim will be approved and that they will be covered for their medical expenses and lost wages as they recover. However, workers’ comp insurers are just like any other insurance company—their goal is to pay out less in benefits than they collect in premiums—and they will work hard to deny your claim. We look at some of the most frequently cited reasons for workers’ comp claim denial.
A Question of Timing
No employer or insurance adjuster is likely to just take your word for the fact that you were legitimately injured on the job. One thing they will consider is the timing of the accident versus your reporting of it. Reasons an adjuster could deny your claim include:
- You didn’t report your injury immediately. Any time that passes between the incident and your reporting of it will be looked at suspiciously, so do not delay in telling a supervisor and filling out an accident report. Kansas requires that you report the accident within 20 days and Missouri allows 30 days, but in either state, you are better off reporting the accident immediately, even if you don’t think you are seriously injured.
- You filed your claim after you were fired or laid off. If you delay filing your claim, you increase the chances that you could be fired or laid off before you actually file. Filing a claim once you no longer work for a company will look to an adjuster like retaliation and will most likely be denied, even if it is legitimate. You do technically have 20-30 days to report an accident, but it will be in your best interest to report right away.
Discrepancies Will Work Against You
Insurance adjusters will examine the evidence and look for any discrepancies to discredit you. Some reasons they could cite for denying your claim include:
- Your injury was unwitnessed. If no one witnessed the accident that led to your injury at work, the insurance adjuster will almost definitely question the claim. While there’s nothing you can do about the lack of a witness, you can protect your claim by reporting the incident to a co-worker and supervisor immediately and that your report of the accident remains consistent each time you tell someone about it.
- Your accident report and medical records don’t align. If your statements about how the accident occurred or the injuries you suffered don’t match up with your doctors’ findings as reported in your medical records, the insurer could deny your claim. The insurance company will be looking for consistency in every statement you make about the accident and will make sure those statements fit with any medical findings.
Your Actions and Reactions Matter
The way you react to your situation could have an effect on the outcome of your claim. If the insurer has any reason to discredit your claim or suspect you are not being honest, he or she could deny your claim. The following actions on your part could jeopardize your claim:
- You were using drugs at the time of the accident. If your initial medical records indicate the presence of illicit drugs or alcohol, your claim will most likely be denied immediately. If the accident occurred because you were impaired by drugs or alcohol, your employer is not required to cover your injuries.
- You refuse to give a statement or release your medical records. You are under no obligation to give a recorded statement to insurance adjusters or to release all of your medical records to them. However, if you are asked to do either of these things, it is probably time to hire a workers’ compensation attorney. An adjuster could deny your claim for refusing to give a statement or release your records and you will need an experienced attorney to counter this denial.
An Experienced Attorney Can Make Sure Your Claim Is Approved
You may not need an attorney to represent you in a workers’ compensation claim. If your claim is straightforward and your accident is well-documented, you probably don’t need a lawyer. However, if you think your claim may be denied for any of the reasons cited above, call our experienced workers’ comp attorneys for a free review of your case. We are here to help.