The Most Common Reasons For Workers’ Compensation Claim Denials
Workers’ compensation benefits are critical for those who are injured on the job; without these benefits, an injured worker may be unable to pay for medical expenses associated with his or her injury and may also be unable to receive compensation for any lost wages or disability suffered.
However, despite the importance of workers’ compensation benefits, and the fact that they are designed to provide workers with benefits regardless of fault when an injury occurs on the job (and the fact that workers’ compensation is required for all employers with five employees or more), workers’ are sometimes denied the benefits they are entitled to. Here’s a look into some of the most common reasons why Mississippi workers’ compensation claims are denied, and what to do if your claim for benefits is disputed:
Common Reasons Why Workers’ Compensation Claims Are Denied
There are several reasons why your workers’ compensation claim, even if perfectly legitimate, may be denied. Some of the most common reasons for claim denials include:
- Waiting too long to report an injury/file a claim. Injured workers are required to report their injuries to their employees as soon as possible after a workplace accident that results in an injury occurs, and always within 30 days. While the employer should report the injury to the insurer to initiate the claim process, if no benefits are paid, the employee only has two years from the date of injury to file a claim with the Workers’ Compensation Commission. If they do not act within the two-year time, they will be barred from compensation.
- Disagreements about how an injury occurred. A worker is only entitled to workers’ compensation benefits if they suffered an injury while doing something within the scope and course of employment. As such, a claim may be denied over a dispute about how an injury occurred, including whether the employee was doing something job-related at the time of incident or not.
Another cause for denial may be a preexisting injury. For example, if an employee had surgery on their knee two years ago and then falls at work, harming the same knee, the insurer may state that the injury was preexisting, and therefore is not eligible for workers’ compensation benefits.
- Lack of medical evidence to support a claim. An injured worker has the right to select one doctor of their own choosing to render treatment following an injury. However, if the worker fails to seek medical care, or there is not enough evidence to support the extent of injury that the employee is claiming, their claim may be denied. It is essential to seek treatment and follow the doctor’s ordersafter a workplace injury. Failure to follow a prescribed treatment plan is another cause for claim denial.
- Claim of employee misconduct. While workers’ compensation insurance is a no-fault insurance system, which means that neither the employee nor the employer need to prove the fault of the other party, a worker’s claim maybe denied if the injury was a result of the employee’s misconduct, such as being drunk on the job or intentionally causing an injury to seek benefits.
What to Do if Your Workers’ Compensation Claim Has Been Denied
If your workers’ compensation claim has been unfairly denied and you have not received the benefits that you believe you’re entitled to, you have the right to appeal the denial and fight for compensation. However, you should not do so without the counsel of an experienced attorney; the appeals process can be legally complex, and evidence will need to be collected and presented to support your claim. When you call our experienced team at the Gardner Law Firm, P.C,. our Mississippi workers’ compensation attorneys will start working on your claim immediately. A consultation is offered free of charge, so please reach out to us today by phone, by visiting our law office in person, or by sending us a confidential message using the intake form on our website. We are reachable at 228-436-6555.