Top Reasons Why Workers Comp Claims are Denied and What You Should Do

You have sustained injuries at the workplace, and you are fully confident that you qualify for workers comp. Unfortunately, even valid workers comp claims can be denied either for mistakes you made during the claim process or for some reasons out of your control.

Quick Fact

Only 7 percent of workers’ comp claims get denied. This doesn’t mean that you don’t take precautions when applying for compensation.

Don’t let this situation happen to you. Talk to reliable boca raton workers’ comp lawyers early enough to get the right representation so that you don’t make a mistake. The lawyer also helps you to deal with issues outside your control.

To prevent your claim from getting denied, you ought to understand the various reasons your claim can be denied so that you avoid mistakes or take action to overcome any barriers. Your claim can be rejected due to:

Failure to Report the Accident in a Timely Manner

The longer you wait, the less likely your claim will be denied. Try and report the incident as soon as you can to your supervisor or the person in charge. Normally, you have 30 days to report the incident; otherwise, your claim will be denied.

You Didn’t Go to the Doctor Right Away

If you have been hurt, the first step is to receive medical treatment from one of the company’s doctors. If you face resistance, visit the emergency room to get prompt medical treatment.

The longer you take before getting treated, the more likely the claim will be denied because the insurer will assume that you were not severely injured to warrant treatment.

You Have no Witnesses

At times you might get hurt when you are working alone. This can complicate the process because you won’t have the right evidence to substantiate the claim. However, the lack of evidence shouldn’t stop you from claiming compensation. Hire qualified boca raton workers’ comp lawyers today to help you handle such a situation properly.

You have a History of Previous Similar Accidents

If you have been involved in previous incidences similar to the current one, the employer might argue that you did it intentionally. However, you must prove that this isn’t the case by providing medical evidence.

It doesn’t mean that just because you have a history of accidents, you aren’t entitled to compensation.

You Lied during the Hiring Process

Some employees hide information during the hiring process. It is vital to disclose significant prior injuries during the recruitment process or after. If you don’t and the insurer realizes this, they can deny your claim.

The Employer Doesn’t Carry Workers Comp Insurance as Expected

In such a situation, the employer can’t pay for your injuries and lost wages. However, as long as the company satisfies the requirements of having workers comp, they are subject to what the law says about compensation.

If your employer doesn’t have workers comp insurance, consult a lawyer so that you understand your legal options and find out how he can assist you in getting compensated.

What Should You do After Your Claim is Denied?

Should your employer deny your workers’ claim, the first thing is to determine why it was denied in the first place. The employer should explain this in detail so that you know what actions to take.

Now that you know why the claim was denied, the second step is to appeal the decision. The letter of denial should spell out the reasons why this happened. Use this letter to file an appeal within the expected time.

Before filing the appeal, talk to the insurer or the employer to find out what happened. At times, it is just a small issue that can be resolved.

If you decide to proceed with the appeal, you need to know that it is a complicated process that can only be handled by an experienced lawyer. You need to have all documentation that can address the reasons for the denial.

Get Expert Legal Help with Your Appeal

If your claim has been denied, don’t despair. As long as you have documents to show that you were injured due to someone else’s fault, you can overturn the denial by working with the right boca raton workers’ comp lawyers. Call us today to find out what you need to do to make a better decision.