When submitting a workers’ compensation claim, knowing what to do (in addition to knowing what NOT to do) is a good way to avoid a denial.
Causes for Denial of Your Workers’ Compensation Claim
When you’re injured on the job and file for workers’ compensation, you feel some comfort knowing you’ll have help covering your medical bills and lost wages.
That is, unless your workers’ compensation claim gets denied.
This can be a devastating blow, especially on top of dealing with your injury or illness.
In an effort to avoid this unfortunate outcome, here are 10 situations that can cause your claim to be denied or rejected by an insurance company:
Prior workers’ compensation claim
Do you happen to have a previous workers comp claim? Insurance companies are on the lookout for possible fraud with employees who have a history of making workers’ compensation claims.
Without a witness, there’s unfortunately a lot of room for an insurance company to try and debunk your story.
Short-term or temporary employee
The workers’ compensation benefits of a short-term or temporary worker can be confusing. The coverage for a short-term employee can differ from state to state and company to company. Don’t automatically assume you’re covered. Check with your employer and/or staffing agency.
Accident after a weekend, holiday or vacation
Coming back from a holiday weekend to report a work injury? No so fast. Trying to prove your claim and show that your injury indeed happened at work and NOT over the weekend will be no small feat.
Upcoming employee layoffs
In a misguided effort to ensure that their paycheck isn’t going to stop, an employee who knows of layoffs coming could try to fake an injury to collect workers’ compensation benefits. At least, that’s what the insurance company might try to say when they deny a claim.
An employee with a record of disciplinary problems will be under additional scrutiny for possibly filing a claim to seek retaliation against an employer.
Refusal to go to approved doctors
If your employer or employer’s insurance company provides you with a list of approved doctors and you choose not to go to those on the list, you’re breaking protocol and ushering in an easy denial of your workers’ claim.
Rumors that you aren’t telling the truth
If there is any word out there that you may not be telling the truth about your injury (especially if you weren’t able to provide a witness of your own), it can be damaging to your case.
Hiring a lawyer
If you were quick to retain an attorney for your claim, this throws up a red flag of possible premeditation to the insurance company. Of course, hiring an attorney to represent you can drastically improve your chances of getting full and fair benefits, so it can still be worth it in the long run to retain legal help as soon as possible — even if your initial claim is denied because of it.
Prior Injury to the Same Body Part
Do you have a preexisting injury to the body part you injured at work? Insurance companies may try to argue that your claim of a current injury is false and instead due to your previous injury.
If you were injured at work, consult with an experienced Atlanta workers’ compensation attorney. Getting the compensation you need is important and a knowledgeable workers’ compensation attorney on your side gives you a better chance of success. Contact Gerber & Holder Law today for your free consultation.
Our Rating is calculated using information the lawyer has included on
their profile in addition to the information we collect from state
bar associations and other organizations that license legal
professionals. Attorneys who claim their profiles and provide Avvo
with more information tend to have a higher rating than those who do
What determines Avvo Rating?Experience & background
Years licensed, work experience, education
Legal community recognition
Peer endorsements, associations, awards
Legal thought leadership
Publications, speaking engagements
This lawyer was disciplined by a state licensing authority in .
Disciplinary information may not be comprehensive, or updated. We recommend that you always check a lawyer's disciplinary status with their respective state bar association before hiring them.