Reasons Employers May Deny Workers’ Compensation Claims

Reasons Employers May Deny Workers’ Compensation Claims

Employers might deny workers’ compensation claims for various reasons. In some cases, innocent and honest employees end up having to hire an attorney in order to enforce their rights and obtain workers’ comp. However, in others, the claims might not be legitimate and end up being denied.

Common Reasons Claims are Denied

There are a handful of reasons why a claim would be denied. Some of the most common include:

  • The employee’s injury wasn’t serious enough.
  • The employee’s injury didn’t take place in the workplace or when doing their job.
  • There was no medical treatment required for the employee’s injury.
  • The employee didn’t need to take any time off of work for their injury.

These are only some of the common reasons why a claim would be denied. There are other reasons as well which are as follows.

It Was an Unwitnessed Injury

Often employers deny claims when there are no witnesses to the injuries. In fact, most of unwitnessed accidents are questioned. If your employee got injured at work but didn’t have any witnesses to back their claim, there really isn’t anything they can do to get workers’ compensation. Regardless, they should still report the injury to you and other co-workers immediately with all details of the injury.

The Claim Wasn’t Filed on Time

Often, workers’ comp claims are denied when the employee fails to report or file it on time. A claim has to be filed immediately, according to the law; typically within a few days of the accident. You, as the employer, will need to inform the insurer and/or state just as quickly.

Pre-Existing Condition

Many jurisdictions won’t even consider pre-existing conditions as a claim for workers’ compensation. For example, if the employee has a lumbar spine degenerative disc disease already and they aggravate their condition with normal work activities causing them back pain, their claim could be denied.

There Are Discrepancies Between Medical Records and the Accident Report

A workers’ compensation claim is often denied if the statements made by an employee about the details of an accident are inconsistent with the medical report. For instance, if an employee tells you that their injury happened one way, but the physician claims it happened another way, this can hurt the employee’s case. Be sure to emphasize the importance to your employees of being consistent with all medical records when filing a claim to help them increase their chances of getting their claim approved.

As a small business owner, having a solid workers’ compensation insurance plan in place is important. This doesn’t mean that every claim will be legitimate and this is a decision that you will have to determine. It will really benefit you to have your attorney ready for any type of workers’ compensation claims.