People get hurt on the job every day. Many times, an injured worker’s claim is denied by the insurance company for no apparent reason to that injured worker.
Through the years, our team has come across many reasons for denying legitimate workers’ compensation claims. Ultimately, the insurance company may be forced to provide coverage for the work accident, but we’d like to share 10 rationales that insurance companies have expressed when denying a claim.
Reason #1: Prior workers’ compensation claims
Have you previously filed a workers’ comp claim? Insurance companies are on the lookout to deny claims for employees who have a history of making workers’ compensation claims.
Reason #2: Unwitnessed accident
Without a witness, there’s unfortunately a lot of room for an insurance company to try and deny what actually occurred.
Reason #3: Short-term employee
Just because you haven’t worked there for a long time does not mean that your injury is not serious and legitimate. Many times a claim is denied if an individual has not worked for an employer for a long time for the sole reason of length of employment.
Reason #4: Accident reported before or after the weekend
Coming back from a holiday or weekend to report a work injury? No so fast. Trying to prove your claim and show that your injury indeed happened at work and NOT over the weekend or vacation will be no small feat. If it’s a holiday, the claim is even harder to prove.
Reason #5: Upcoming employee layoffs
When a company announces mass layoffs, many legitimate injuries are denied under the auspices that the injured worker is attempting to keep their employment.
Reason #6: Discipline history of the injured worker
An excuse that many employers’ give for denying a claim is the past disciplinary history of the injured worker. Most times this has absolutely no effect on their subsequent work injury and is merely reasons for delay and denial of a legitimate claim.
Reason #7: Refusal to go to approved doctors
If your employer or employer’s insurance company provides you with a list of approved doctors that complies with state regulations and you choose not to go to those on the list, you’re breaking protocol and ushering in a potential denial of your workers’ claim.
Reason #8: Rumors that you aren’t telling the truth
If there’s any word out there that you may not be telling the truth about your injury, it can be damaging to your case. Most often this is baseless and purely retaliatory
Reason #9: Hiring a lawyer
If you were quick to retain an attorney for your claim, this throws up a red flag of possible premeditation to the insurance company. Of course, hiring an attorney to represent you can drastically improve your chances of getting full and fair benefits, so it can still be worth it in the long run to retain legal help as soon as possible — even if your initial claim is denied because of it.
Reason #10: Prior injury to the same body part
Do you have a pre-existing injury to the body part you injured at work? Insurance companies may try to argue that your claim of a current injury is pre-existing and instead due to your previous injury.
Receiving a denial for your workers’ compensation benefits can be frustrating. Contacting a knowledgeable Atlanta workers’ compensation attorney gives you a better chance of success and securing the compensation you deserve.