Attorneys Robert, David and James Cody

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Reasons for workers’ compensation claim denials

On Behalf of | Oct 27, 2023 | Work Injuries |

Workplace injuries can result in considerable physical, emotional and psychological costs. Besides pain and distress, workers often face exorbitant medical bills made more stressful by the fact that they may not be able to work for a period.

Workers’ compensation insurance helps ease the burden of an injury by covering medical expenses, rehabilitation and lost wages. Claims can end up rejected for a number of reasons.

Missed deadline

One of the primary reasons for denial is a delay in reporting the workplace injury. Minnesota law requires employees to report injuries to their employer within 14 days. Reporting an injury as promptly as possible helps avoid denials for this reason. There are also specific deadlines for filing claims. If the employer fails to file within the appropriate time, the insurer may deny the claim.

Lack of medical evidence

Accurate and timely medical documentation is important for supporting a workers’ compensation claim. If the medical records do not clearly establish the connection between the injury and the workplace incident, the insurer is likely to deny the claim. Obtaining proper treatment and a diagnosis from a doctor right after the injury occurs helps prevent this.

Dispute over cause

One of the main conditions individuals must meet to qualify for workers’ compensation is that it must occur because of the job. If the employer argues that the injury occurred outside the scope of employment, the claim might face challenges. Providing clear and consistent details about the incident is important in such cases.

If the employer or insurance company can demonstrate that the injury is a result of a pre-existing condition and not directly related to the workplace incident, it may result in claim denial. However, if the workplace incident aggravated the pre-existing condition, a valid claim could still exist.

Policy violation

If the injury occurred while the employee violated company policies, such as engaging in horseplay or being under the influence of drugs or alcohol, the claim could be invalid. Employers have the right to deny claims if the injury resulted from the employee’s misconduct.

According to the U.S. Bureau of Labor Statistics, there were almost 64,000 workplace injuries and sicknesses in the private industry in 2021. Workers’ compensation exists to help people injured at work. Because of this, an initial rejection may cause discouragement. However, denials are not uncommon. Individuals can appeal them, and often the reason for the denial is something easily fixed.