Imagine suffering a bad injury while at work, or doing something related to work, and then being told you will not be getting any compensation for your injuries.
On asking for their reasons for denying your claim, you’re told things like, “You do not meet the requirements,” or insurers doubt you were injured at work. So, how do you deal with such situations?
Instead of panicking, you can take a step back and figure out what happened. This article will get into five reasons why your worker’s compensation claim may be denied.
1. Deadlines: Failure to Report the Injury
Whenever you get hurt at work, the first step should be to report it. You have a short window to do so, beyond which your claim isn’t valid. In such moments, a workers’ compensation attorney can help you file your claim before the deadline.
A lot of things can cause a delay in filing your claim.
- Lack of documents: Your case will only be legitimate if you file relevant paperwork. It’s best to have the assistance of an attorney to do this, as you may not be aware of all the procedures or documents involved.
- Deadline to file: Report the injuries within a week of their occurrence. If you wait too long, you may miss the deadline, and the delay could be used to invalidate your claim.
2. Conflicts: Disputes About the Cause of Injury
Failure to accurately explain the cause can lead to a denial, especially when details like where the injury happened or what caused it appears inaccurate or fabricated. If you don’t include the following information, the claim will be denied:
- The actual place: Claims for injuries suspected to have occurred outside the workplace will be denied, so you must give a precise location.
- The task you were doing: If you were outside of your workplace but on a job assignment, be sure to include proof. Work-related tasks done outside the workplace also qualify for compensation. If this isn’t verifiable, your claim will be denied.
3. Limited Evidence
Insurance companies require that you prove an injury actually occurred, like you claim. If you fail to, the insurer has no obligation to meet your demands. Some reasons for denials are mentioned below.
- Missing medical report: Medical reports are critical to proving your injuries and the extent of physical harm. Without these records, the insurer cannot approve your claim.
- Conflicting stories: How, when, and why did you get injured? If your story and that of your employer differ, the insurance investigation team will not grant your application for compensation.
4. Paperwork Issues: Errors or Incomplete Documents
There is a lot of paperwork involved, so you better be ready for the exhausting document filing ahead. Your attorney can also take care of this for you. The following are some common errors that can lead to a denial:
- Misunderstanding and incomplete paperwork
- Suspicion of fraud due to the missing or incomplete filing of necessary information
- Missing deadlines automatically leads to denials
- Lack of credibility and reliability since there is no paperwork to claim or back your story
5. Challenges to Your Claim
Even after doing everything expected and being diligent, any legal challenge from employers or insurers can put your claim at risk. Work with the employer to get your story straight and ensure every detail is captured in your claims filing. Also, make sure your lawyer is present to help you create a rebuttal for any challenges.
Conclusion
Despite documenting injuries and meeting the requirements for a claim, it can still be denied if you don’t file your claim on time. So, it’s important to get your documentation right.
Ensure you have a good lawyer to defend against any legal challenges. With all this in mind, you can be sure your claim will be granted without objection.
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