Assisting Clients Across California Since 1993

Avoid these top reasons for workers’ compensation denial

When you’re injured at work, you need financial support to offset your lost wages and your medical expenses. The workers’ compensation system could provide you with the relief that you need, but these benefits aren’t automatically handed out. In fact, a fair number of workers’ compensation claims are denied, which could leave you struggling to get by as you try to focus on your recovery.

How can you decrease the risk that your workers’ compensation claim will be denied? One of your first steps should be to educate yourself on common reasons for workers’ compensation claim denials, that way you know what you need to avoid. That said, let’s look at some of the top reasons why workers’ compensation claims are denied.

It may not seem like it at first, but there are a lot of justifications for denying a worker’s compensation claim. These include the following:

  • The injury occurred outside of work: To obtain workers’ compensation benefits, you have to demonstrate that your injuries were suffered on the job while you were performing work-related duties. If you suffered an injury outside of work, your employer and their insurer are likely to find out, at which time they’ll deny your claim. This issue often comes up when people are injured during breaks or during their commute to work. In these instances, workers’ compensation likely won’t apply.
  • Medical care wasn’t sought out: You need supporting medical documentation when pursuing workers’ compensation benefits. Without it, your employer’s insurance company probably isn’t going to take you at your word. In these instances, then, you’re claim will be denied. We know there’s oftentimes an urge to tough out injuries and avoid going to the doctor, but if you’ve been injured on the job, then you need to seek out immediate medical care and secure any recommended follow up treatment.
  • Pre-existing condition: If you have a pre-existing condition, then the insurance company is going to latch onto that fact to argue that your injury isn’t covered by workers’ compensation. You can still recover workers’ compensation benefits if your pre-existing condition was exacerbated at work, but this is a nuanced argument that’s going to require a detailed opinion from your medical provider.
  • Procedural errors: The workers’ compensation process has a lot of deadlines and notification requirements that have to be met. If you don’t adhere to them, then your claim will be denied. So, be sure to understand the rules that are applicable to your claim.
  • The injury was suffered during horseplay: As mentioned above, to recover workers’ compensation benefits, you have to show that your injuries were suffered while performing your work duties. If you were hurt while doing something you weren’t supposed to be doing at work, then you won’t be covered.
  • You continue to work: You have to miss work in order to secure workers’ compensation benefits. If you try to tough it out and stay on the job, then your employer’s insurance company isn’t going to deem your injuries severe enough to warrant coverage. So, be sure to discuss your work with your attorney so that you know how to address this aspect of your claim.

Don’t lose out on the workers’ compensation benefits you need

It may not seem like it at first, but there’s a lot of nuance that goes into a workers’ compensation claim. If you want to maximize your chances of recovering the financial support that you need, then you have to understand the ins and outs of the process and what you can do to reduce the risk of claim denial.