Some of the reasons for denying Workers' Compensation Claims are injuries sustained outside of the workplace, medical attention not sought, missed deadlines, and having a pre-existing condition.
FREMONT, CA: Workers' compensation laws gained traction in state legislatures only in the early 20th century. In the past, injured workers in factories, railroads, offices, farms, and more had no recourse. Even with stricter safety regulations across industries today, workers' compensation laws still offer important protections, such as paying medical costs and lost wages to employees who get hurt or become ill. According to the Insurance Information Institute, nurses and personal care aides account for nearly 15 percent of reported workers' compensation cases, but injuries and illnesses can occur in many types of work.
Employees injured on the job are covered by workers' compensation insurance, which covers medical costs, lost wages, and other expenses.
As a result of these policies, employers are also protected from the significant financial burden associated with workplace injuries and illnesses. A worker's compensation policy is mandated by most states, but the laws and procedures for filing a claim and complaints vary from state to state, so it's best to consult an insurance professional or lawyer.
Based on information from industry experts and media sources, Simply Business compiled a list of common reasons workers' compensation claims get denied. The following are some of the common reasons why a claim might be denied.
Outside-the-workplace injuries: If no one sees a person fall at work, did it actually happen? Without witnesses, injuries can be difficult to prove. Accidents that occur during breaks or on the way to or from work are not considered occupational hazards. In order to determine whether an injury is covered, workers may need to discuss their situation with an attorney who is acquainted with the definitions of work environment and work-related.
Did not seek medical attention: It is necessary to obtain a medical evaluation, even for seemingly minor injuries, in order to document the extent of damage and the need for treatment. The National Safety Council reports that many accidents are caused by exposure to harmful substances or environments, so it is important to see a medical professional if workers believe that they have been exposed. Medical professionals can help the workers document the extent of these injuries, even if they feel healthy enough to work. When employees fail to provide medical records for their claims, they may be denied coverage.
Deadline missed: Organizations should note what needs to be included in their workers' compensation claim and by when they begin the process. There are different rules for how employees can file claims in different states, so workers should check their state's rules before filing. Benefits can even be denied due to clerical errors. It may seem insignificant, but missed deadlines are a common and legitimate cause of employees losing compensation. Workers' compensation claims may also be rejected for not following the correct procedure if organizations fail to notify their employer of an injury promptly.
