Workers’ Compensation: 10 Common Reasons You’re Denied Claim~6 min read

You got hurt at work, sought treatment and then stayed home so you could rest and heal. At this time, you are supposed to now receive weekly workers’ compensation payments via check or direct deposit. And, in some cases, this is exactly how workers’ compensation works. But for others, their case ends in a workers’ compensation denial.

Why was your workers’ comp claim denied? Every situation, employer, injury, and insurance company are different, but here are 10 common reasons why your workers comp claim may have been denied.

1. No Workplace Injury

The concept of a workplace injury is crucial to your workers’ compensation claim and BOTH of these conditions must be met:

1. The injury must have occurred during the course and scope of your employment and the injury must arise out of the employment.
2. These are highly fact sensitive questions, but workers’ compensation laws are designed to make it easier than in a usual case to prove the injury happened at work. That being said, it can still be difficult to prove and having an experienced lawyer will help.

2. Your Injury Isn’t Covered

Workers’ compensation isn’t a government-funded program, but a type of insurance policy. Some injuries may be the result of a work injury, and some may be blended between something that happened at work and something at home. It is important to have an attorney help prove what is related to the work injury to maximize your coverage.

3. Waiting To Report The Injury

You can have limited time following your injury to file a workers’ comp claim. If you let this time pass without notifying your employer or the insurance company, this can result in your claim being denied.

Unfortunately, some bad apples commit workers’ comp fraud and this has led insurance companies to be suspicious of workers’ comp claims, especially if certain conditions are met. Waiting too long to file your claim makes it look as though you are not injured (at least, not seriously).

And it’s even worse if you are fired or laid off before you get around to reporting the claim. This can make it look like your motivations were more about revenge than recovery.

4. No Witnesses

This is not a guarantee that your claim will be denied, but is one of the reasons workers’ comp claims are denied.

An injury with no witnesses or video footage is more likely to raise suspicion, as there is no one to back up your claim that you were injured at work. (This is even more so the case if you delay reporting the accident.)

5. Discrepancies In Your Report

Before they accept or deny your workers’ comp claim, the insurance company will carefully review all of the evidence available to them. If there are discrepancies between the report you filed at work and your medical record, they are likely to deny your claim.

Having a workers’ compensation lawyer on your side will help mitigate any filing mishaps to ensure your claim is thoughtfully handled.

6. Pre-Existing Condition

Let’s say you notified your employer that you had scoliosis when you arrived for your first day of work. They provided you with all the necessary equipment to prevent injury, but you pulled your back out anyway.

However, your workers’ comp claim was denied because your back pain was a “pre-existing condition.”

This is not a case when a claim denial should occur, but it often does. The truth is, if a workplace accident makes a pre-existing injury worse, you are still entitled to compensation.

Again, this is where having the right legal representation on your side to represent your case will ensure a fair review.

7. Lack of Cooperation

In some cases, you may be contacted by the insurance company to provide a recorded statement describing your accident and injuries. If you refuse to give a recorded statement (which is well within your legal right), your claim can still be denied because you “didn’t cooperate.”

At other times, the insurance carrier may require you to sign a medical release form allowing them to contact your doctor directly for your medical records. If you refuse to sign, your claim may be denied.

8. Intentional Injuries and Employee Fault

The very existence of workers’ comp proves the importance of workplace safety.

Getting intentionally hurt, being intoxicated at work, or engaging in reckless conduct (like a fight with a co-worker) may result in a denial. These are highly sensitive fact inquiries, and require an experienced lawyer to navigate to ensure you get the coverage you need.

9. There Were Illegal Drugs in Your System

Workplace safety is the key component of preventing injuries and reducing expensive workers comp claims. Many insurance companies are now offering discounts to companies who follow the rules of a drug-free workplace program.

Under these rules, employees are required to submit to a drug test:

• after they receive a conditional offer of employment;
• if their employer suspects substance abuse;
• any time their employer requests it.

As a result, your employer may have all employees take a drug test following any workplace accident. If illegal drugs are present, your workers comp claim can be denied.

10. You Were The Aggressor In A Fight

Violence is rarely thought of as a cause for workplace injury, but it’s more common than you might think. This is particularly true with healthcare providers who may be dealing with patients who have mental/emotional conditions causing them to act out physically.

As an example: Two people are at work with one minding his own business and going about his normal job duties while another worker walks up and punches the first worker in the face. If you’re the aggressor in a fight at work, your claim can be denied.

If you are not the aggressor, however, you may be entitled to workers’ compensation benefits.

Contact the Law Offices of Parnell, Michels & McKay

The workers compensation system exists to provide employees with medical evaluation and treatment as well as a source of income while they recover from injuries that happened at work. If you believe your workers comp claim was unfairly denied, you have the right to fight back.

At the Law Offices of Parnell, Michels & McKay, our workers’ compensation attorneys have over 30 years of workers’ compensation experience in New Hampshire and Massachusetts. Our knowledge of the workers’ compensation laws allows us to tailor our legal advice to the specific needs of each client. Call or contact us today!

At Parnell, Michels & McKay we specialize in personal injury law such as motor vehicle accidents, falls, dog bites, workers compensation, social security disability, and other injuries. We also practice family law, including divorce, post-divorce, unwed custody and property division, and collaborative divorce. We have extensive experience in bankruptcy, probate, boundary disputes, estate planning, corporate formation and other real estate litigation.