Having workers’ compensation insurance is mandatory for employers as per federal laws that aim to benefit injured or sick employees at work with medical treatment, wage replacement, occupational training, survival benefits, and more. However, similar to all other types of insurance programs and claims, Charles Spinelli says that workers’ comp claims can also be challenged or denied. Having a clear insight into the leading reasons that an employee’s workers’ comp claim was denied is crucial and such denials can be avoided by understanding the legal rules and guidance that both employees and employers need to adhere to. So, for victims who are wondering why their claims were denied, keep reading to explore some of the common mistakes.
Incomplete, incorrect, or delayed claim submission
If the claim form filled in by the injured worker or his/her family man is found incomplete, or there is incorrect information, the insurer carrier has the authority to reject the claim paper. Moreover, it is important for workers to note that filing a claim beyond the deadline as specified in the state rule is one of the primary causes of claim application denial. Adherence to standard deadlines and the correctness of paperwork not only increases the likelihood of claim approval but also lessens delays and denials of claims.
The worker was under the influence of drug
If it is found that the worker was under the influence of alcohol or drugs while on the work, the claim gets denied automatically. Employers and doctors under the network are instructed by the law to undergo an alcohol and drug test instantly after a workplace injury takes place.
The injury took place during the lunch break
If the employee was at lunch at the time the injury happened, there is a possibility of the claim being denied. However, if the worker was involved in any job related to the workplace as per the instruction of the employer or supervisor either the worker should be considered illegible for a worker’s compensation claim or it will fall under personal injury. Make sure to speak to an experienced worker’s compensation insurance lawyer for needed assistance.
The worker overlooked receiving medical care from any approved doctor
In almost all cases, workers’ compensation insurers provide a list of healthcare providers under their network while injured or sick workers on the job must get treated by them after an injury. Receiving treatment from a doctor or hospital that does not have the approval of the insurance company may not be granted causing a claim denial. According to Charles Spinelli, in exceptional cases, like if the injury was critical and compelled the worker to visit the nearest emergency care facility, the emergency treatment is most likely to be covered by workers’ compensation.
The ailment or injury is co-related to any pre-existing condition
Noteworthy, for workers who had a pre-existing condition or previous injury while the new claim is found an aggravation of the issue or injury, there is a possibility that the insurance company might deny the claim.
To avoid all these mistakes, it makes sense to consult with a workers’ compensation claim lawyer who will make sure that all paperwork is correctly filled and suggest other areas enabling an injured worker to get compensated as per law.
