5 Reasons Why Workers’ Compensation Claims are Denied
Workers’ Compensation is a system that is supposed to be beneficial for both employees and employers. Employees receive “no-fault” coverage for work-related injuries and illnesses, meaning they should receive compensation for medical bills, rehabilitation costs, time missed from work, and related expenses regardless of who is at fault. In exchange, employees are generally barred from bringing a civil lawsuit against their employer for a covered incident.
In principal, workers’ comp should be a self-executing system; you get hurt and work, and you receive coverage for your injuries. Unfortunately, in practice, it does not usually work out this way. Filing a workers’ compensation claim is a complicated process, and claims are denied by insurance companies all the time.
There are several reasons why workers compensation claims are denied, here are five of them:
- You did not notify your employer and/or file the paperwork on time
In Mississippi, you are supposed to notify your employer within 30 days of suffering an injury or illness at work. Your employer is then required to report the injury to their insurance company and/or the Workers’ Compensation Commission. While you may give notice orally, it is best to notify your employer in writing, so you have record of it. There is also a two-year statute of limitations from the date of a work-related injury to receive benefits. If no benefits have been paid within the two-year window and the employee has not filed an appeal with the Workers’ Compensation Commission, the employee may be barred from receiving benefits.
- You do not have supporting medical evidence of your injuries
Although you should notify your employer within 30 days of a work-related injury or illness, you should seek medical attention as soon as possible. Employers and insurance companies are highly skeptical of claims that are made when the employee does not see a medical professional right away (or at all). If you do not have supporting medical documentation, the insurer may claim that you faked the injury and/or made false or misleading claims. In Mississippi, employees have the right to choose one doctor or medical provider for treatment. This same doctor or medical provider can also refer you to a specialist without insurance company approval. Be sure to exercise this right and see a medical professional as soon as is convenient after you are injured.
- There is a question about the origin of your injury or illness
Workers’ compensation provides coverage for work-related injuries only. In some cases, your employer or their insurer may claim that your injury or illness is not work-related. For example, they may say that you had a preexisting condition, or that the illness/injury was caused by a third party or factors outside of work. Along these same lines, a similar reason for denial would be an injury that is the result of alcohol, drugs, self-inflicted, co-worker assault, or other willful violations of employer policy. If there is any question about how your injury or illness occurred, there is a good chance your employer’s insurer will at a minimum delay the claim and eventually deny it.
- You are not eligible for workers’ comp benefits
The vast majority of workers are eligible for benefits under Mississippi Workers’ Compensation laws. There are some exceptions, however. Examples include:
- Employees who work for companies that have fewer than five employees;
- Employees who work for non-profit organizations;
- Domestic or farm labor employees;
- Most independent contractors.
If you fall into one of these categories, you may not qualify for workers’ comp benefits. That said, employers are sometimes mistaken when they claim an employee is ineligible. In addition, ineligibility for benefits does not necessarily mean you cannot bring a personal injury claim against your employer or the party responsible for your injury. These situations can get complicated, and it is best to speak with an experienced workers’ compensation lawyer to fully assess your situation and go over your rights and options.
- Your employer disputes your claim
There are some cases in which an employer simply disputes your workers’ compensation claim in bad faith. For example, your employer may deny that the accident ever happened or try to minimize the incident and claim that you really weren’t hurt as badly as you say. An unethical employer may wrongfully deny a claim, so their insurer will not have to pay out benefits and they will not have to pay higher workers’ comp insurance rates. When this happens, it may be the basis for a bad faith lawsuit. If you are in this situation, it is important to have strong legal counsel in your corner to aggressively pursue just compensation on your behalf.
If Your Mississippi Workers’ Compensation Claim was Denied, Don’t Give Up
If your workers’ comp claim was denied, this is not necessarily the end of the line. You have the right to file a Petition to Controvert with the Mississippi Workers’ Compensation Commission and have your case assigned to a judge. This is a complex process, however, and you need a skilled attorney by your side who thoroughly understands state laws and has a successful track record with these types of cases.
At Gardner Law Firm, we have proudly served workers in Southern Mississippi since 1979. We understand the frustration employees feel when their workers’ compensation claims are wrongfully denied, and we put our extensive experience to work to help clients recover the benefits they need and deserve.
For a free consultation with one of our seasoned attorneys, call our office today at 228-436-6555, or you may send us a secure and confidential message through our online contact form.