Why Your Legitimate Workers’ Compensation Claim Could Be Denied

Doctor discussing exam with a patientWhen you are a hardworking, dedicated employee, you expect your employer to do the right thing and provide you with the workers’ compensation benefits you are entitled to if you become injured on the job. Sadly, the workers’ comp insurance company for your employer does not care about good work ethics and being fair. It is a business looking to make money by denying claims like yours or paying less than you are entitled to.

Common Reasons Your Claim Might Be Denied

Unfortunately, legitimate claims for workers’ compensation benefits are denied all the time. While a claim can be disputed for many reasons, there are some common ones that insurance companies use frequently. If you received a letter denying your claim for benefits, one of these reasons could have been listed:

  • Injury not filed in time. Under Georgia law, you are required to report your injury to your employer immediately after the accident—or as soon as practical—but no later than 30 days after the date of the accident or the injured employee’s death. There are other strict time periods for filing a claim for medical benefits and for partial or full disability benefits that you are required to meet as well. If you fail to meet these deadlines, your claim could be denied. A common avoidable reason this issue could come up is if you do not believe you were hurt in the accident. Since symptoms could take days or longer to develop, your best strategy is to report your accident immediately whether you think you were injured or not.
  • Disputed claim. Your employer could dispute that your accident occurred while you were performing work activities. These issues can be more complex if you must travel for work, travel between job sites, or are on an errand at the request of your supervisor.
  • No witnesses. Unfortunately, insurance adjusters commonly dispute a workplace accident occurred when no witnesses saw your accident. However, this is not a valid reason to deny your legitimate claim.
  • Pre-existing injuries. If you suffered a pre-existing injury to the same body part injured in your work accident, the insurance adjuster will try to argue that the prior incident and not your accident at work caused your injury. An experienced workers’ compensation attorney will have strategies to defeat this argument.
  • Discrepancy between your accident report and medical records. If your accident report and medical records contain statements by you as to how the accident occurred that are inconsistent, the insurance company could doubt you were even hurt at work. You can avoid this problem by being consistent. Often you may not realize you were hurt until you seek medical treatment or your symptoms develop, so these initial discrepancies should not be used to deny your claim.
  • Under the influence of drugs. If your medical records show you were intoxicated or under the influence of drugs right after your accident, you should expect your claim to be denied.
  • Fired or laid off. If you delayed filing your claim and then were fired or laid off, the insurance adjuster will be suspicious that you are filing your claim in revenge for your employer’s actions.
  • Recorded statement refusal. The adjuster could insist that you must give a recorded statement—a question and answer session about the accident and your injuries that is recorded—and will deny your claim if you refuse. However, a recorded statement can be used against you in your workers’ comp case. You are not required to give one, and you never want to agree to give one without the advice of an attorney.

What Should You Do If Your Claim Is Denied?

If your workers’ compensation claim is denied, you need to hire an experienced workers’ compensation attorney  as soon as possible who can help you appeal your denial and build your case so you obtain the benefits you are entitled to. Review my testimonials from other satisfied clients and then call our firm at 888-795-6261 today to schedule a free, no-obligation consultation to discuss your situation.