We’re starting a new series that takes a closer look at some of the most common reasons for workers’ compensation injury claims denials. Each week, we’ll spotlight a specific reason for denial, talk about why the insurance company gave this ruling and discuss some tactics for overcoming the decision. Today, we are looking at the most common reason an injury claim gets denied, which is a dispute of medical causation.
Medical Causation Dispute Denials
When the insurance company cites causation as the reason for denial, they are not disputing that an accident took place, that you have real injuries or that you require medical treatment. However, they are disputing that the work accident was the true cause of the existence of your injuries. They may argue that you had a preexisting condition that worsened during your shift, or they may say that you actually suffered your injuries off the clock. Whatever the specific reason, they are going to say that your work incident was not the true cause of your symptoms.
The unfortunate reality is that many injured workers accept this ruling as final, or they may agree that they had some pre-existing pain that worsened as a result of an incident at work. We want to make it clear that the presence of a pre-existing injury does not mean you are ineligible to collect compensation if the issue worsens. For example, if you tore some cartilage in your knee in college and then ended up tearing your ACL at work, it’s certainly possible that the previous injury impacted the overall stability of your knee and made you more likely to eventually tear your ACL, but that doesn’t render you ineligible for benefits. The insurance company can’t deny benefits because you had other issues with your knee in the past. If a new injury develops or an old injury significantly worsens, you can still collect workers’ compensation.
There are also times where the insurance company can rightly deny a claim based on causation. If you type regularly at work but are also an amateur writer in your free time, the insurance company may deny your claim for carpal tunnel injury benefits because your injuries are just as likely to be caused by your actions outside of work than directly arising from work duties. They’ll look to find any way they can to deny your claim, and saying that your injuries weren’t the direct result of work duties is a common argument the insurance company will make.
The best way to counter a medical causation denial, and most denials in general, is by syncing up with a workers’ compensation attorney. They’ll be able to read over your primary liability determination letter and figure out exactly why your claim was denied. Moreover, they already know the best ways to counter common reasons for denials. We know how to use your testimony, witness accounts, doctor examination reports and additional evidence to build a clear connection between your work accident and the onset of your injuries. A denial letter should never be the end of your case, and it doesn’t have to be if you work with an experienced injury lawyer.
For if your claim was denied over causation concerns, or if you want help building a strong injury claim that has an increased chance of being approved on the first try, connect with Dean and the team at Margolis Law Firm. Give our team a call today for a free case evaluation. (952) 230-2700.
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