Common Reasons Why Workers Comp Claims Are Denied

If you suffer a workplace injury, you are legally entitled to claim workers’ compensation from your employer. If your employer has four or more employees, it is required by South Carolina laws to carry workers’ compensation insurance. This type of insurance is meant to cover the medical costs, lost wages and other unexpected expenses in the wake of an injury.

However, you are required to meet certain requirements when seeking workers’ compensation. When these requirements are not met, an employer may refuse your claim. You can avoid this by understanding the key requirements and other reasons which most often lead to workers’ comp denials. You can also contact an experienced Greenwood workers compensation lawyer today. Here’s a look at some of the reasons you may have been denied:

You Didn’t Report the Injury Immediately

Workers’ comp injuries must be reported at the earliest. If you suffer an injury at the workplace, it is important that you notify your supervisor about it as soon as possible. You must also fill out an accident report and submit it to your supervisor. Many workers’ comp denials happen simply because the claimant is too late in filing the report. When you file the report too late, the insurers grow suspicious and are less likely to look at your claim favorably.

Your Injury Wasn’t Work-Related

Workers’ compensation insurance covers all work-related injuries. However, defining what types of injuries are considered work-related and which ones aren’t is somewhat tricky.

Here’s an example to illustrate this more clearly. If you were at your office and suffered an accident, you are owed workers’ comp benefits. Similarly, if your employer organized a New Year’s party and you were injured at the party, you can still claim benefits.

However, if you were at work, then took a half-hour break to head out and sustained an injury while away from the office, you won’t qualify for benefits. In many cases, benefits are denied when your injury is not clearly and demonstrably work-related.

You Didn’t See a Doctor

It is important to see a doctor after you suffer a workplace injury. This is because when you subsequently file for benefits, you will be asked to provide medical records to back your claim. And these records can exist only if you visit a doctor for the injury. In many cases, employees try to handle an injury on their own. And when they seek workers’ comp benefits for the injury, they fail because no medical proof exists to back their claim.

You Didn’t See an Approved Medical Provider

After you receive initial medical help, it is important to visit a healthcare provider approved by your employer or the insurance company. Such a healthcare provider is able to verify the nature and extent of your injuries. You can typically choose one from a whole list. In some cases, you may be able to choose your own healthcare provider but only if your employer approves. When you don’t see an approved healthcare provider, your employer or the insurer may use this as a reason to turn down your claim.

You Provided Inconsistent Details

Following the workplace injury, you may share details of it with the supervisor, employer, doctor, colleagues and others. If there are inconsistencies in the story you tell, this will cast a bad light on your claim. Most importantly, the details you share with your doctor and those you provide in the accident report must match. If you report one set of facts for the accident report but tell your doctor that the injury happened differently, this can lead to claim denial.

You Were Under the Influence At the Time

If you suffered a workplace injury while being under the influence of drugs or alcohol, you are not entitled to workers’ compensation. There are some exceptions to this, however. For instance, if the injury occurred at a casual event organized by your employer where alcohol was provided by the employer, then you can claim benefits for an injury incurred even after consuming alcohol.

Hiring a Workers’ Compensation Attorney in Greenwood, SC

Filing a workers’ compensation claim and having it approved can be a tough process. In addition to the common causes for denial listed above, insurers and employers may use various other pretexts to reject your claim. This is why it is always helpful to have a Greenwood workers’ compensation attorney by your side.

Here at ASB Law, we have been working with workers’ comp claimants for a long time. Our attorneys specialize in helping applicants file their claims and seek approval in the briefest time possible. We can also help you avoid and counter common objections cited by employers and insurers. Contact us today to book a FREE consultation with our attorneys.

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