Why was My Workers’ Compensation Claim Denied?December 21, 2020
Getting hurt at work is an unpleasant experience. As equally unpleasant is being denied Workers’ Compensation by an insurance company. Any claim could be turned down for various reasons. The following are questions to ask a Workers’ Compensation lawyer when receiving a claim denial:
Did the Worker Report the Accident Promptly?
Workers injured on the job need to take care of their medical problems. They should also contact their supervisors and human resources personnel promptly. This gives the company time and opportunity to create an incident report. If an employee waits too long to update the employer about the accident, the insurance company might assume the accident did not occur at work at all. Many insurers will suggest that a worker’s injury actually happened somewhere else, and that the worker is attempting to game the system. Having no record of speaking with a manager puts the employee in a bad position.
Did the Worker See a Doctor?
Employees who believe they suffered a work-related injury owe it to themselves to be seen by a medical professional as soon as possible. Trying to tough it out could backfire. A Workers’ Compensation adjuster might balk at the idea of approving a claim for someone who never sought medical attention.
Even injuries that seem insignificant should be checked out by a family physician or someone at an urgent care facility. This sets up two benefits; first, if the injury is more severe than it looks, the worker can seek proper treatment. Secondly, the doctor’s report can be used to substantiate that the injury happened when and how the employee said it did.
Was the Worker Engaged in Horseplay?
A workplace accident that happens because of fooling around or roughhousing between co-workers is unlikely to be covered by Workers’ Compensation. Most companies maintain strict policies about expected behaviors between colleagues.
The horseplay could be the result of one worker playing a prank on another worker. In that situation, the hurt employee might be able to collect Workers’ Compensation because that employee was a victim of a practical joke and not a willing participant.
Was the Worker’s Paperwork Not Completed Correctly?
A surprising amount of Workers’ Compensation denials come back to one problem: The paperwork was done incorrectly or sent in after the deadline. Workers’ Compensation requires quite a bit of documentation and writing. Employees who ignore timelines or submit partial answers should not be surprised at receiving an initial denial. Workers who feel that they are unable to complete Workers’ Compensation paperwork on time may want to contact a lawyer.
Was the Worker Under the Influence at the Time of the Accident?
An employer will fight against paying out Workers’ Compensation to an employee who tested positive for alcohol or illegal drugs at the time of the accident. An intoxicated worker will rarely be covered by a Workers’ Compensation. There could be a catch, however, if the employee was taking prescription medication that affected balance, strength, or some other response. In that circumstance, the worker might need reports, eyewitness accounts, and medical documentation to prove there was no deliberate intoxication.
If I am Denied Workers’ Compensation, is My Case Over?
Workers have the right to appeal a denied claim. Typically, employees with significant injuries will turn to a Workers’ Compensation lawyer to improve their likelihood of getting an approval the second time around. Lawyers have the experience, resources, and bandwidth to help their clients collect information and present a strong, comprehensive case for an initial denial to be overturned.
Media Workers’ Compensation Lawyers at the Law Office of Deborah M. Truscello Assist Hurt Employees with Denied Claims
If you received a Workers’ Compensation denial after submitting your claim, speak with one of our Media Workers’ Compensation lawyers at the Law Office of Deborah M. Truscello. Call us at 610-892-4940 or contact us online for a free consultation. Located in Media, Pennsylvania, we serve clients throughout Bucks County, Chester County, Delaware County, Lancaster, Montgomery County, Norristown, Philadelphia, Reading, and West Chester, Pennsylvania.