Reasons a Worker’s Comp Claim Might be Denied

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Robert Golan

Unfortunately, accidents happen and when they happen at work, most employees assume that they will be covered by workers compensation. When they are informed their claim has been denied it is common to feel frustrated, scared, stressed, and disheartened.

Denied workers compensation claim Queens, NY

There are many reasons a claim might be denied and having a worker’s comp lawyer to help you fight the denial is key in getting the claim decision reversed. Here are some reasons that a claim might be denied.

1.  Eligibility

Workers compensation is for those employed by a company and may not extend to contractors or freelancers. At times, an employee may be incorrectly classified by their employer and having an experienced worker’s compensation attorney to assist in proving that you meet the employment status requirements is vital.

2.  Severity

Illness and injuries entitled to workers compensation must be severe enough to need medical treatment and/or to cause an employee to need time off work. Treatment of minor cuts and bruises from a job won’t typically be covered under worker’s compensation. While a cut that becomes infected due to equipment or chemical exposures at work might be eligible.

Each state has guidelines about what injuries are eligible for worker’s comp claims.

These guidelines can change, so it is a good idea to consult a lawyer who can look at the individual circumstances of your injury, and go to bat for you if your injury should be classified under workers compensation even if it previously is not.

The injury must also meet the state guidelines for severity to be covered.

3.  Missed Deadlines

It is important to inform your employer as soon as your injury occurs. If you don’t inform your employer promptly, wait too long for treatment, or fail to submit requested paperwork by the deadline, your claim may be denied. The time you have to report your injury and file can vary from state to state.

4.  Nature of Injury

If you were injured while off the clock or doing something outside the scope of your duties, your claim can be denied. This can include something as seemingly innocent as being injured as you are horsing around with a coworker. Despite being on the clock and at work, if you weren’t injured in the scope of your duties, your claim may be denied.

At times, your doctor may attribute your injury or illness to workplace duties, but the worker’s compensation board will disagree. A lawyer can help you fight the denial and show that your injuries did occur within the scope of your job duties.

5.  Company Policies

Some employers have specific medical providers they work with when an employee is injured on the job. Employers may require an employee to have a drug or alcohol screening.

If you did not follow company guidelines for treatment, your claim may be denied.

6.  Employment Status

If your employment ended before you filed a claim, that claim may be denied. Depending on why your employment ended, a lawyer may be able to argue against this claim, especially if you believe you were fired by your employer as a result of filing for worker’s compensation benefits.

7.  Pre-Existing Condition

Sometimes illnesses or injuries can be made worse by work done on the job. In those cases, you still may still be eligible for workers comp. If you live in Long Island, NY get a free case evaluation today.

8.  Inconsistencies or Errors

A wide range of causes fall under this category:

  • If your injury was unwitnessed or if the medical reports don’t align with the workers compensation report, the claim may be denied.
  • If your employer claims your version of events is inaccurate the claim may be denied.
  • If you are viewed as being uncooperative, your claim can also be denied. It is understandable that after an injury you might be concerned about the paperwork you are being asked to sign or being asked leading questions that you feel uncomfortable answering.

Hire an Excellent Workers Compensation Attorney to Help Avoid Denied Claims

A good workman’s comp lawyer, such as Robert Golan, will be able to help you cooperate in the investigation while protecting your rights.

There are many reasons a worker’s compensation claim may be denied. Because of this, it is best to get a lawyer involved in the process as early as possible to help you avoid preventable pitfalls that might lead to a claim denial.

However, if your claim has already been denied it’s not too late.

If you live in Long Island, Queens, Nassua, or Suffolk New York, Robert Golan can help. He offers injury at work advice and a free case evaluation. Call Robert Golan at 516 586 3910.  He is also a lawyer for disability appeals. Wherever you are in the workers’ compensation filing process, Robert Golan is here to help.

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