4 Common Reasons for Work Comp Claim Denials

Reasons for Work Comp Claim Denials

Workers’ compensation is a system in place to help employees who are injured or become ill as a result of their job. In most cases, it’s a no-fault system, which means that the employee doesn’t have to prove that the employer was at fault in order to receive benefits. However, work comp claims can be denied for a variety of reasons.

In fact, almost half of all workers’ compensation claims are denied in some way! That’s a pretty staggering number, and it means that if you’re injured on the job, your chances of claiming the full benefits you need may be questionable. But don’t worry – with the help of a good lawyer, you can increase your chances of having your claim approved.

Here you’ll explore 4 examples of denied work comp claims and what to look out for so that you don’t make the same mistakes. Stay safe on the job and read on!

What are some Common Reasons for Work Comp Claim Denials?

Common Reasons for Work Comp Claim Denials

Example 1:  Employer Disagrees about the Nature of the Accident

One common reason for work comp claim denials is that the employer disputes the employee’s version of events. This can be tricky to prove, but if you have witnesses or video footage, it can help your case. For example, you can try to document the event using your smartphone or using security cameras.

Here’s one common scenario:  an employee slips and falls on a wet floor at work. The employer denies the claim, saying that the employee should have been more careful. However, if there are security cameras that show that the floor was in fact wet and slippery, this can help to prove the employer’s negligence.

Example 2: Injury Happened Outside of  Work, Presumably

Another common reason for denials is when the employer says that the injury didn’t happen at work. They can claim that you got hurt in the gym, at home, or while running errands. Some examples of injuries that they can try to contribute to non-occupational factors include :

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Injury Happened Outside of  Work

  • Carpal tunnel syndrome. While you can get it as a result of long and constant work in front of a computer, your employer or insurance company can argue that it is due to long hours of gaming or other non-work related activity.
  • A back injury from lifting something heavy at home. If you recently moved home, they can argue that you got injured from lifting heavy boxes, furniture, or appliances from the truck.
  • An ankle sprain. While you may get it from hitting a random table or wall in the office, it may also be from an injury you sustained while playing soccer, for example.

To combat this, you’ll need to show that your injury is in fact work-related. This can be done by providing documentation from your doctor that confirms the time, date, and nature of the injury. Make sure to have copies of these documents with you and provide them to all parties, including your worker’s compensation attorney in Los Angeles.

Example 3: You Missed the Deadline

You have just waited too long and didn’t know what is the deadline. Surely, you have suffered a job-related injury, but you thought that you had unlimited time to claim benefits, or relied to paying your medical bills from your own pocket. Many employees are unaware of their rights and the deadlines for filing a claim, which can lead to them being denied benefits.

Denied Adequate Medical Treatment

For example, in the state of California, you have just one year from the date of your injury to file a claim. If you miss this deadline, you will likely be denied benefits. Deadlines have a purpose in the system, and they show whether you are entitled to benefits or not.

Example 4: You were Denied Adequate Medical Treatment

You were injured at work, but when you went to the doctor, they told you that your injury wasn’t bad enough to warrant treatment. This can be frustrating, especially if you’re in pain. However, this is a common reason for claims to be denied.

To combat this, you’ll need to get a second opinion from another doctor. This doctor can confirm the severity of your injury and provide the documentation needed to support your claim. Be aware that you are entitled to professional medical care under the law of the State of California.

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Vivek Baghel is a Professional Blogger, Writer and likes to write on various niches as well as all about the latest news. He’s also Admin of Oshup.com a tech blog and shares Tech, News, SEO articles, and the Latest News.
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