Employers must have a workers’ compensation insurance program for their workers, so employees can receive the financial support and medical care needed to recover from workplace accidents. While the intention of workers’ compensation seems easy enough, it can quickly become a complicated matter. If you or someone you love is considering filing for workers’ compensation benefits, we highly encourage you to talk with an attorney for help from the start.
There are many ways that an employee’s claim may get mishandled or wrongfully denied. By having a legal professional on your side, you are more protected from such things happening to you.
When an Insurance Company Denies the Claim
In some cases, the employer’s insurance company will deny the injury claim submitted by the employee. The insurance company can benefit from rejecting a claim, because this means they won’t have to spend money taking care of the worker’s medical treatment. If you were recently denied from receiving workers’ compensation benefits, you do not have to accept this willingly. With help from an attorney, you can file an appeal for reconsideration.
Why Claims May Be Denied
When the employee receives notice that their claim has been denied, there may be several reasons as to why this decision was made. Unfortunately, an employer may have played a role in the claim being rejected. An employer may intentionally turn in the paperwork late or incomplete, in hopes this increases the chances of the application being turned down. An employer who is under pressure to save the company money, may unlawfully mishandle the worker’s paperwork. Reasons why claims may be denied can include:
- Failing to Inform Employer of the Accident On-Time: each state has specific laws as to how long an employee has to report the injury to their employer. A worker who reported the incident too late, may receive a claim denial.
- Insufficient Documented for Injuries: an injured employee must seek medical care right after the accident. It is vital to abide by doctor’s recommendations and restrictions during the treatment plan. An employee who doesn’t have enough proof that the injuries occurred or violated physical limitations, may have their claim denied or canceled.
- Lack of Witnesses: if an employee cannot identify witnesses for the accident, the insurance company may try to claim the incident didn’t happen or wasn’t work-related.
- Alcohol and/or Drug Use: the insurance company will probably deny an employee’s claim if testing shows they had drugs or alcohol in their system at the time of the workplace accident.
It can be difficult to battle a denied workers’ compensation claim alone. The average person doesn’t know where to begin when sending in a request for reconsideration to the company’s insurance agency. A Brooklyn on the job injury lawyer can apply strategy when submitting the workers’ compensation claim, to increase your chances of being approved the second time around. If you believe your employer may be influencing the insurance company’s decision, please let an attorney know right away.
Thank you to our friends and contributors at Polsky, Shouldice & Rosen, P.C. for their insight into workers compensation and denied claims.