When Can Workers Compensation Be Denied?
Employers are required to provide workers’ compensation coverage for all employees. In many states, including Pennsylvania, even if you were partially or completely responsible for your injury, your employer must provide coverage for your medical bills, lost wages and other expenses. Yet, too often, legitimate workers’ compensation claims are denied. There are several reasons why your workers’ compensation claim may be denied.
If there were no witnesses to your injury, there is a chance that the workers’ compensation insurer will question that the injury occurred while you were on the job. There is not much you can do if you are injured without witnesses. However, if you report the injury immediately to your co-workers and your employer, there is less chance the insurance company will deny your claim.
Failure to File Immediate Report
If you are injured on the job and wait a few weeks to report it, chances are your claim will be denied. In some states, you are required to report a workplace injury fairly quickly, sometimes within seven days. If you don’t report it immediately, the insurance company may determine your injury does not qualify. Even if your injury appears minor, complete an accident report and notify your immediate supervisor as soon after the accident as possible.
Accident Report and Medical Record Discrepancy
If there is a discrepancy between the report you filed with your employer and the medical report filed by the doctor, your claim may be denied. Never fabricate details of a workplace accident. Doctors now have medical technology that can determine what most likely led to your injury, so if you have claimed the injury happened one way when it actually happened another way, your claim will more than likely be denied, even if the incident did happen on the job.
Drugs or Alcohol
If medical testing indicates drugs or alcohol in your system, your claim may be denied. Even if you were not substantially impaired, the presence of drugs or alcohol may make you ineligible for worker’s compensation.
Filing a Claim After Dismissal or Lay-Off
If you file a worker’s compensation claim after you are fired or laid off, the claim will most likely be denied, even if you were legitimately injured on the job. In most cases, the insurance company looks at such claims as revenge claims. If you are injured, report it immediately even if you suspect you will be fired or laid off in the near future. This does not guarantee the claim will not be denied, but it will look less like a revenge filing than if you wait until after you have been dismissed.
Refusing to Provide Statement or to Sign Medical Releases
In some cases, the insurance company will ask you to provide a recorded statement. They may also ask you to sign a release that allows them access to your medical records. You are under no obligation to provide a recorded statement or to allow unlimited access to your medical records. Unfortunately, when you refuse to provide the statement or allow access to your medical records, the company may deny your claim.
If you or a loved one has filed a workers’ compensation claim that has been denied for any reason, contact the workers’ compensation lawyers at Lundy Law to learn what rights you may have. You can arrange for an initial, no obligation consultation by calling 1-800-Lundy Law or by completing the easy form on our website.