Common Reasons Why Workers’ Compensation Claims are Denied

Sustaining a work-related injury can have a devastating impact on your quality of life. Many injured workers rely on workers’ compensation to pay their bills and get the medical care they need, but sometimes a claim will get denied. There are several reasons why employers and insurance companies reject workers’ compensation claims.

Injured Worker isn’t Considered an Employee

In order for a person to be eligible for workers’ compensation, he must be classified as an employee when the injury occurs. Whether the employer is responsible for paying the worker’s wages and has the right to terminate his employment are two of the factors taken into consideration. It can also be argued that an employer-employee relationship exists if the employer is in a position of authority and has the right to control how the work is executed.

Employee Doesn’t have Work-Related Injury

The employer could argue that the accident never happened on the premises or the injury isn’t work-related. In this type of situation, the employee needs to prove that his medical condition is connected to the performance of his job duties. The facts regarding how the injury occurred are crucial. The employee can submit medical records and statements from his doctor that attribute the injuries to the workplace conditions. If the employee was injured due to a specific accident at work, other people who were present can testify on the employee’s behalf about what transpired.

Injured Employee was Intoxicated

If the employee was intoxicated at the time of accident, the employer will likely dispute the claim. When it appears that intoxication from alcohol or drugs was a factor in the employee getting injured, he could lose his right to receive workers’ compensation benefits. If the employee was incapacitated due to the use of prescription medication, his workers’ compensation claim may still be valid.

Failed to Provide Notice of the Injury within 90 Days

The employee is required to notify the employer of the injury within 90 days. Even though there are a few exceptions to this rule, it’s important to inform a supervisor or manager of the injury in a timely manner. If the employee was hurt due to a hazardous work condition, the employer can quickly take measures to fix the problem before someone else is harmed. When the employee takes a long amount of time to report the injury, the employer may not believe that the employee was really hurt.

If you consult a workers comp attorney, he can evaluate your case and discuss your legal options.