Common Reasons Why Your Amarillo Workers’ Comp Claim Was Denied

Tormey & McConnell May 12, 2022

Workers compensation is an essential part of your safety at work. It’s a no-fault form of insurance that almost every employer is required to carry which, by law, helps to cover you if you get hurt in the course of your job. Regardless of what caused the injury, workers’ comp helps to cover your medical bills, a portion of your lost wages, and even, if necessary, vocational training for new jobs.

Unfortunately, workers compensation insurers get very overzealous in trying to keep fraudulent claims to a minimum. This results in far too many legitimate claims getting denied the first time out. Learn the reasons why workers compensation claims are denied, what you can do if you get a rejection, and how a workers comp lawyer can help.

Why Was My Claim Denied?

There are many reasons why workers’ compensation claims can be denied. These include failure to report injuries in a timely fashion, a lack of witnesses to the injury, discrepancies in your paperwork, indications of illegal drug use, filing of claims after being fired, or a refusal to sign authorizations, among others.

Failure to Report in A Timely Fashion

There is a statute of limitations on reporting injuries to get a workers’ comp claim. The longer you take to report your accident, the less likely you are to get your claim approved. Insurance companies don’t like to pay out damages and they will look for any reason they can to undermine your case. This includes accusing you of not being that badly hurt because you took too long to report your injury.

A Lack of Witnesses

Insurance companies never like to award claims if there aren’t any witnesses to the incident. If there’s nobody that can back up your story, they’re going to challenge every aspect of it they can. Without someone to support your story, there’s not much you can do to fight these challenges, but that doesn’t mean you shouldn’t report your injury. The best way to combat a lack of witnesses is to tell your story often, to many different people, and keep all the details the same.

Discrepancies in Paperwork

If your statement on your initial report differs from what appears on your medical records, your claim can be denied. When you report the accident to your supervisor, make sure the story you tell your doctor is exactly the same. Even the smallest difference in details can cause problems. This isn’t to suggest that you’re not telling the truth, but it’s always best to keep your story as simple and straightforward as possible.

Indications of Illegal Drug Use

If you go to the ER after an accident at work, and they find illegal drugs in your system, the insurer will almost definitely deny your workers’ comp claim. This is an important thing to remember due to the fact that, while many states are legalizing marijuana, it is still an illegal drug at the Federal level. The insurance company can latch onto this as an excuse to accuse you of being irresponsible and to deny your claim as a result.

Filing a Claim After Being Fired

Sometimes you might get injured at work, and for whatever reason, you delay reporting or filing your claim. Then you get laid off or fired. If you then take the opportunity to file your claim, you may well see it denied, as the insurance company will assume that you’re only firing as revenge for being let go.

Refusing to Sign Paperwork

Part of your workers’ compensation claim is going to involve a lot of signatures. You’ll have to give a statement describing your accident and injuries, which can be problematic. If the insurance company asks you to sign a statement it can often mean they’re looking to challenge the statement. You’re also not legally required to issue the statement. Refusing to give the statement, however, opens the door for them to accuse you of having something to hide.

Likewise, you’ll be asked to sign medical authorizations that allow the insurer access to your healthcare records. You’re not required to allow this—you can provide whatever records they need directly. Again, however, they might accuse you of having something to hide.

Call a Workers’ Comp Lawyer

Your best bet any time you need to file a workers’ comp claim is to immediately secure the services of a workers’ comp lawyer. An attorney can help you to take the right steps to avoid claim denials and get the compensation you deserve. If you need help, call the Tormey & McConnell law firm for a free consultation today.