Insurance companies aren’t profit giants because they blindly award claims to every person who files an injury claim. Instead, they carefully review each and every claim to look for reasons to deny payments. Sometimes there are major red flags with the worker’s story, while other times a clerical oversight is all that’s needed for the insurance company to deny your claim. Today, we take a look at five of the most common reasons why your work injury claim may be denied, and how you can avoid a claim denial.
Why Your Work Injury Claim Was Denied
Here are five common reasons why an insurance company will deny your workers’ compensation claim:
1. Missed Deadlines – There are a lot of deadlines you must meet when it comes to reporting your injury, getting a medical evaluation and filing your claim. If you miss one of those deadlines, the insurance company will happily deny your claim. Avoid this by reporting your injury right away and by contacting a lawyer who knows all the deadlines and can make sure you meet each one.
2. Incomplete Paperwork – Filing a workers’ compensation claim is a complicated process, and all it takes is one unchecked box or a missed form and you can earn yourself a denial. Again, your best bet is to hire a workers’ compensation lawyer. We know all the forms that need to be completed and can make sure everything is filed as necessary to get you an approval.
3. Pre-Existing Condition – The insurance company is going to do their homework, and if they see you’ve been dealing with back pain for years, they may deny a claim for compensation for a back injury on the grounds that they believe you’re actually dealing with a pre-existing condition and not a specific work-related injury. If you believe you may be denied because of a pre-existing condition, consult with a lawyer and your evaluating physician to help distinguish the new injury from previous pain reports.
4. Potential Fraud – You may also get your claim denied if the insurance company has reason to suspect that you’re fraudulently attempting to collect compensation, even if you’re trying to file a legitimate claim. If the insurance company suspects that the injury didn’t occur during work hours, or something else with your story seems fishy, even if it’s the truth, you can have your claim denied and have to challenge it with further evidence in front of a judge. Again, a lawyer can help you file a claim in such a way that your story doesn’t flag for potential fraud.
5. Varying Stories – If your version of events varies enough from the version your manager provides, the insurance company may decide to deny your claim. If you’re worried that management might not share the true version of events, be sure to get statements from witnesses who can verify your claim.
For more tips on dealing with work injury claim denials, or for help after your claim denial, reach out to Dean and the team at Margolis Law Firm today.
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