Coye Law Firm

4 Common Reasons Why Your Workers' Comp Claim May Be Denied

If an employee is hurt while on the job, an employer may be responsible for paying workers’ compensation benefits. Those benefits may include reimbursement for medical bills, payment for authorized doctor’s visits, physical therapy, prescription drugs, mileage reimbursement for traveling to and from authorized doctors and pharmacies, and lost wages.

The employer or its insurance company will sometimes look for whatever reason possible to deny a workers’ compensation claim. For an employer, denying a claim means decreasing insurance expenses and liability.

4 Common Reasons for Denied Workers’ Comp Claim

1) You Didn’t Report the Injury in Time

One reason why an employer and insurance company may deny a workers’ compensation claim is that it was not reported within the state’s prescribed time period. It varies from state to state, but an employee should report his or her claim as quickly as possible.

In Florida, you have 30 days from the time the workplace accident happened to notify your employer. Although verbal notification (such as simply telling your boss about the accident) is acceptable, you can better protect yourself by filing a First Report of Injury report.

2) You Failed to Seek Medical Care

You must get treatment within two years of a workplace accident. Failing to use an approved medical provider after receiving emergency care can result in a denial of benefits. Your employer might say you must not have been badly injured if you waited to go to the doctor, or that you were actually injured in an event outside of work.

You should request of your employer treatment from an authorized doctor or specialist so that you have documentation to prove the injury. But not only that, you should also seek the most documentation of your injury as possible. Ask your doctor or specialist for detailed reports, rather than general ones, and copies of any X-rays and MRI’s that are taken. You may want to consider keeping a journal of your injuries, doctor visits and specifically the dates and details of what occurs.

3) The Accident Did Not Occur on Company Time or Within the Scope of Your Employment

If your injury occurred before or after normal work hours, your injury may not be covered. Your employer may also claim that your injury occurred outside the scope of your employment, or that it was the result of horseplay.

4) There is a Potential for Fraud

Employers and insurance companies may also deny a claim for benefits, alleging that the employee is committing fraud in order to receive workers’ compensation benefits. For example, an employee with a previous injury might claim they hurt their back while working when they happened to have a herniated disc in the past. If the insurance company asks the employee if they’ve had back injuries in the past and the employee says no, they may raise fraud defense to claim that the employee’s injury was a result of past medical conditions and not from an accident at the workplace.

There is also some controversy over drug testing in a workers’ compensation claim. If your employer is making you take a drug test during an open claim, it can seriously affect your case.

3 Things You Can Do to Start Fighting for Your Workers’ Comp Benefits Today

Finding out that you have been denied workers’ comp benefits is not the end all, be all. If your employer refuses to pay benefits, or is slow to pay benefits for a qualified injury, you can fight back.

1) File a Petition for Benefits

petition for benefits is a mini-lawsuit you can file in order to have various issues heard before a judge. Watch my free video here to learn more about the process.

2) Get Independently Evaluated

Employers tend to try to push you towards medical professionals who will be favorable to their position. An attorney can help you make sure you are receiving a fair medical exam.

3) Learn More About Your Rights

Brush up on your rights as an injured employee and download a FREE copy of Wade Coye’s book, Sharing the Secrets, Learning the Lies: A Guide to Florida Workers’ Compensation. You can also contact our expert team by calling (407) 648-4940 today or by filling out a contact form.