You followed the rules perfectly, but now your workers' compensation claim has been denied. You might be able to get your claim back on track if you take certain actions. If that doesn't work, you still have alternatives to just giving up. Read on to find out more.
Common Denial Issues and How to Act
1. The injury did not happen at work. If the workers' comp insurer can claim that your injury is not connected to your job, you may get denied. What you will need is both a knowledge of workers' comp coverage and some corroboration. You are covered for the following work-related situations, in addition to any incident that occurs during your time on the clock:
- Traveling in a work vehicle.
- Traveling out of town for job-related events, training, appointments, etc.
- Attending work-related trainings or events off-campus.
- On a lunch break – but only if you were on company premises or fetching lunch for a supervisor.
- An occupational illness or medical condition that began away from work but was worsened by working conditions. For example, you might have been diagnosed with high blood pressure and were being treated for it. Your job, however, is very high-stress and you had a heart attack as a result.
The other issue is corroboration. Try to find as many coworkers as possible to provide statements about the accident or illness. You may also present other forms of proof, such as journal entries and postings on social media. Also, check for video camera evidence of the incident.
2. You are accused of being under the influence of drugs or alcohol. If you were taking an illegal or forbidden substance during work and were hurt, you may be denied benefits. However, workers who take prescription medications should not be punished for treating a medical or mental condition. Be ready to appeal the decision and provide proof of your prescription.
3. Claim form issues pop up. Some claim forms are unnecessarily complex, and that can lead to mistakes and omissions. If your claim was denied due to a problem on a claim form, phone the workers' comp insurer and see what can be done to get things straightened out. When you sign your claim form, look it over and address empty spaces, incorrect names, times, dates, and other errors. Be sure the summary of the accident remains the same regardless of who you speak to. Make a copy of your claim form before it gets sent in.
When a hurt worker cannot work and has been denied coverage, things can get serious. When problems with your employer or the insurer crop up, speak to a workers' compensation lawyer about your case.