May 28, 2024 | Workers' compensation

Being injured at work can be a devastating experience. However, the troubles don’t end there. For many workers, a workplace injury will have a big impact on their finances. They are faced with high medical bills, not being able to earn a living as they take time off to recover and some are even faced with the possibility of never being able to make a living. Fortunately, the workers’ compensation system is designed to provide workers with the financial resources they need during this difficult time.

Why Workers’ Compensation Claims are denied

Workers’ compensation is a no-fault system designed to provide workers with financial resources to deal with the economic pressures that workplace injuries and occupational illnesses can present. However, not every claim is accepted. Below are some common reasons why workers’ compensation claims might be denied.

1. Failing to report the injury or illness in a timely manner

One of the primary requirements for filing a workers’ compensation claim is prompt reporting. Workers are required to alert their employer of their illness or injury within a stipulated time. If you let this deadline pass before reporting the injury to your employer, it can cause your claim to be denied. Delays in reporting can also lead to skepticism regarding the legitimacy of the claim.

2. Lack of medical evidence

While workers’ compensation is a no-fault system, evidence of the injury must still be provided. Insufficient medical documentation supporting the injury or illness can result in claim denials. It’s essential to seek medical attention promptly and thoroughly document all related medical records and treatments.

3. Not following medical advice

It is essential that you follow the steps outlined by the doctor following your injury or diagnosis of your illness. Any deviation from the instructions provided by your healthcare provider can not only result in complications but can also be used by the insurance company as grounds for denial of your workers’ compensation claim.

4. Seeking medical care from an out-of-network healthcare provider

Employers and the insurance companies that represent them often have specific healthcare providers that you may use when seeking treatment for a work-related injury or illness. If workers seek treatment from a healthcare provider that is not in this network, they may have their claim denied. The only exception to this is for emergency medical care.

5. Disputes over causation

Another common reason that insurance companies deny claims is when there are disputes over causation. The insurance company may argue that the injury or illness did not occur at work or as a result of work conditions.  This is often the case when there are no witnesses or when dealing with chronic conditions.

6. Pre-existing conditions

Claims may also be denied if the injury or illness is deemed to be the result of a pre-existing condition rather than a workplace incident. Establishing a clear connection between the work environment and the injury or illness is crucial in such cases.

How Hiring an Attorney Can Help

Dealing with a denied claim can be frustrating especially when you are injured and facing mounting medical bills and other expenses. Don’t give up. The experienced and skilled workers’ compensation attorneys at High & Younes Attorneys, LLC can help resolve the situation. Here’s how we can help.

1. Expert guidance through the appeals process

Our attorneys have years of experience handling workers’ compensation cases. We are familiar with the laws and processes governing workers’ compensation claims. We can guide you through the appeals process and fight to ensure you recover the benefits you are entitled to.

2. Gathering and presenting evidence

Our team will use our resources and expertise to gather evidence to support your claim. This includes medical records, witness statements and expert opinions. We will work to strengthen your case and refute the reasons for the denial.

3. Negotiating with insurers

Our attorneys are experienced and skilled negotiators. We will level the playing field when negotiating with the insurance company. Our attorneys will advocate for your rights and negotiate for fair compensation for medical expenses, lost wages and other damages.

4. Representation in hearings

If your case proceeds to a hearing, our experienced attorneys will be by your side. We will represent you at your hiring and ensure that your interests are protected throughout the legal proceedings. We will build a strong case and present it on your behalf.

Conclusion

Workers’ compensation is designed to provide the medical and financial support injured workers need following a work related injury or illness. However, the claims process isn’t always as straightforward as many would like to believe. Claims may be denied. If your claim has been denied don’t hesitate to reach out to High and Younes Attorneys, LLC for help. We’ll fight to recover the benefits you deserve.

Workers Compensation Claim Denied?