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Common Reasons a Workers’ Compensation Claim May be Denied

On Behalf of | Feb 1, 2024 | Workers' Compensation |

Workplace injuries can be challenging, and employees often rely on workers’ compensation to cover medical expenses and lost wages. However, there are instances where those in charge may deny a workers’ compensation claim, leaving individuals in a difficult situation.

These are some common reasons for claim denials.

Failure to report promptly

One factor leading to claim denials is the failure to report injuries quickly. Employees need to notify their supervisors or employers as soon as an injury occurs. Delayed reporting can raise doubts about the legitimacy of the claim.

Lack of medical documentation

Accurate and complete medical documentation is important for a successful workers’ compensation claim. If an injured worker fails to provide detailed medical records or seeks treatment from an unauthorized healthcare provider, the legitimacy of the claim could be under scrutiny. Follow proper channels to establish the link between the injury and the workplace.

Discrepancies in witness statements

Inconsistent witness statements can pose a significant hurdle to a workers’ compensation claim. If the statements provided by the injured party, coworkers or other witnesses do not align, it may create doubts about the accuracy of the incident. Ensuring consistent and truthful accounts of the events leading to the injury is important for a successful claim.

Pre-existing conditions

Pre-existing medical conditions can complicate workers’ compensation claims. Insurance providers may look at claims more closely if there is a pre-existing condition that could contribute to the reported injury. People need to be transparent about their medical history while demonstrating a clear connection between the workplace incident and the new injury.

Violation of workplace policies

Those in charge may deny claims if the injured employee violated workplace policies, such as drug or alcohol use, engaged in horseplay or failed to use provided safety equipment. Employers and insurance providers may argue that the injury resulted from actions outside the scope of regular work duties.

Workers’ compensation benefit expenses reached a total of $58.9 billion in 2020. There are several important elements in ensuring a smoother claims process. By being aware of these factors, employees can better secure the support they need after a workplace injury.