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3 Reasons an Insurer May Deny Your Workers’ Compensation Claim

Attorney Mark Rufo PC

All jobs come with a certain level of risk. Industries such as construction, manufacturing and agriculture naturally have heightened ones.

Workers’ compensation offers a way for injured workers to obtain financial aid during and for recovery. However, insurers deny many claims for a variety of reasons.

1. The employee or employer did not report the incident and injury promptly

To reduce the chance of rejection due to improper reporting, workers need to report their injuries to their employers as soon as possible. This helps ensure that they can gather all the proper details and evidence as accurately and swiftly as possible. Employers then need to file a report with the insurer that includes information about the injury, what led to it and any witnesses.

2. The injury is not work-related

Insurance companies often look for any reason to avoid paying benefits. They may claim that an individual’s injuries are due to personal or outside reasons, not work ones. This is especially common with conditions that develop over a period, such as repetitive strain injuries, where it is hard to prove the cause or pinpoint a start date. The company may try to label an injury as a pre-existing condition.

3. The employee was partially or fully at fault

Intoxication or reckless conduct at work disqualifies individuals from receiving workers’ compensation for injuries received while in such a state or performing such behavior. It is not uncommon for insurers to try to show that workers engaging in unsafe behaviors led to an accident.

An initial rejection does not signal the end of the road. It is possible to challenge denials and win. Individuals may even go through more than one before receiving benefits.