When a Workers’ Compensation Claim May Be Denied

Many people who are injured at work hope they can get good workers’ compensation. Accidents that lead to injuries in the workplace can have life-changing effects on the victim. The worker may end up with permanent physical damage, may lose wages, or may have to receive long-term treatment and/or care.

But while workers’ compensation can be a great way to cover expenses that arise following workplace accidents, some claims get denied. Why does this happen? Whether you’re currently dealing with this or simply want to know what to do in case your claim got denied, this article has all the information you need.

You Have Pre-existing Health Conditions

One thing that insurance companies like to do to avoid compensating victims is to blame pain, injury, and suffering on preexisting medical conditions. For instance, if you fell and injured your leg, the insurance company may try to say that your pain is from an accident that you had 10 years ago.

Now, there are cases when a victim has preexisting health conditions, but that doesn’t mean the insurer should exaggerate the condition or use it as an excuse not to pay you for the new injuries. No preexisting issue makes you unqualified for compensation in the event of a workplace injury, which is why you should hire an experienced workers’ compensation attorney who can help you out.

The Papers Were Not Filed on Time

Each state has its own statute of limitations when it comes to workers’ compensation claims. For instance, in New Jersey, you have two years from the date of the injury to file for workers’ compensation. Therefore, you must look for a New Jersey workers’ compensation lawyer who can help you file on time.

If you don’t file your papers on time, your claim will get easily denied by the employer and insurance company, especially if the deadline passes. Keep in mind that you have to consider the deadlines even for injuries that develop over time.

You Did Not Seek Medical Care

Following any type of injury, you must seek medical treatment, especially when you think you may have a case against the negligent party. If you were injured at work, then medical treatment can help you assess the extent of your injuries and ensure you obtain proof that will help you during the claim.

Employees must make sure that they get medical attention even for injuries that they believe will heal over time. These injuries may end up getting worse, which then only ruins your chances of winning.

The Injury Resulted from Horseplay

It’s not unusual for employees to have some fun at times. Work can get boring and stressful, so workers look for ways to relieve stress and have a great time. If you end up goofing around with your coworkers and get injured, then don’t be surprised if your claim is denied.

When you goof around during your work hours, the insurance carrier might claim that you were not taking care of your job duties, so the injury is your own fault. It’s even worse if they have evidence that you were not doing what you were supposed to do at the time of the accident.

You Got Injured During Your Lunch Break

Sometimes, claims get denied when a worker gets injured during their lunch break. In some cases, these injuries do not fall under the guidelines for workers’ compensation, which is why automatic denials happen.

However, you may be able to figure something out if you speak to an experienced attorney.

You Were Intoxicated at the Time of the Accident

Using intoxicating substances is not allowed at work, and you probably know this. If you were the victim in a work accident and your alcohol or drug consumption caused it, then you will most likely not have a lot of success when pursuing your claim.

When you seek medical care for your work-related injury, your employer can ask that you take an alcohol and drug test to see if you were under the influence. If tests come back positive, then expect your claim to be denied.

The Bottom Line

There are many situations when workers’ compensation claims can get denied. This might happen when you cause the accident by being intoxicated or when you get injured during your lunch break, when goofing around with colleagues, or when not filing on time. For this reason, it’s best to hire a good lawyer who can make sure you get the compensation you deserve.

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