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personal injury claim

Almost all employers are required to provide workers’ compensation coverage for their employees. Workers’ compensation is a no-fault insurance, which means you may be eligible for coverage even if you were at fault in the accident. Therefore, it may be surprising when your workers’ compensation claim is denied. These are the top eight reasons worker’s compensation claims are denied.

You Were Not on the Job

Workers’ compensation covers injuries on the job only. You must have been performing your regular job duties in order for the injury to be covered. If you are driving to meet a client and are injured in a car accident, for example, workers’ compensation would cover your injuries. However, if you were sitting in the break room having lunch and the chair broke and caused an injury, that may not be covered under workers’ compensation because your lunch hour is not actually part of your workday.

Failure to Notify Employer

The insurance company may deny your claim if you failed to notify your employer of your injury in a timely manner. Failing to report the injury immediately could result in your employer being unable to investigate what happened. It could also give the impression that you were not actually injured at work but somewhere else and are simply trying to file a claim to get your medical bills covered.

Keep in mind that the injury must happen at work while you are performing your job duties so you want to be sure the evidence indicates you were actually working at the time of the injury.

Under the Influence

Although most claims will be paid even if you did something that led to your injury, workers’ compensation does not have to pay a claim if you were under the influence of drugs or alcohol. Your employer has the right to request that you be tested for either drugs or alcohol after an accident. If it is found you have either in your system, your claim will likely be denied.

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Failure to Seek Medical Treatment

Even if you reported your injury to your employer, if you did not seek medical attention, your claim may be denied as well. You will want to see a doctor as quickly as possible after a workplace injury in order to ensure your claim will be successful.

Failure to See Approved Medical Provider

Your employer may also have the right to require you to see a specific doctor in order to obtain treatment. Even if you believe the required medical provider is purposely downplaying the severity of your injury, something that often happens, you must see that doctor in order for your claim to be successful.

Delay in Filing Paperwork

Workers’ compensation claims require a significant amount of paperwork and it can be overwhelming at times. It is critical that you submit all paperwork in a timely fashion as delays could result in a denial of your claim. Read all documents you receive, and try to complete them to the best of your ability. If you have any questions, you should contact the worker’s compensation company to seek assistance.

Horseplay or Practical Jokes

You and a co-worker are tossing around a ball in the warehouse when you lunge to catch it and fall, breaking your arm. Because you were involved in what is known as “horseplay,” the workers’ compensation company may not have to cover your injury. In the eyes of most insurance companies, horseplay, roughhousing or practical jokes are not part of your job and the injury may be viewed as occurring during a break.

Pre-Existing Conditions

An injury or condition you had before you started working for your employer cannot be used for a workers’ compensation claim. You can also not claim workers’ compensation for any injury you sustained outside of work. However, if something that happens at work aggravates a previous injury, it is possible you can claim workers’ compensation. For example, a fall that makes an older back injury worse may be eligible for compensation.

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If you have been injured at work, you can prevent your claim from being denied by talking to an attorney. If your employer or their insurer already denied your claim for benefits a lawyer can also appeal the decision.