Workplace injuries are unfortunately frequent, especially in industries that require a lot of physical or repetitive labor. When you are injured at work, you primarily depend on your employer’s workers compensation policy to take care of the related medical bills.
But what if your employer denies a workers compensation claim?
Generally, employers are unable to legally deny filing a workers compensation claim. If you are injured at work, you are legally entitled to file a workers compensation claim through your employer with their insurer.
Exclusions to the Rule
In some cases, employers may be able to reject a workers compensation claim. For example, if an employee does not report their injury or illness to their employer within a certain amount of time (generally less than 30 days after the injury), the employer may deny the claim. This is because delayed claims are often viewed as the employee not being injured enough to qualify for compensation.
There are also other times where a workers compensation claim may be denied by the actual insurer. Even if you file a workers compensation claim in a timely manner with your employer, their insurance provider may still deny your claim if:
- There is no evidence
- The injury occurred while the employee was under the influence of drugs or alcohol
- The injury occurred in a fight that the employee initiated or provoked
- The injury occurred while the employee was goofing off, off the clock or otherwise not working
- The employee refuses immediate medical treatment
- The employee does not see an approved medical provider as specified by the workers compensation policy
- Medical attention is not sought in a timely manner
Failing to provide evidence or follow the rules as listed by the employer’s workers compensation policy is a quick way to have a compensation claim denied. When a claim is denied, the employee will not receive any compensation from the insurer and will instead be responsible for covering the expenses of their injury out of pocket or through other health insurance means.
To avoid a denied claim, make sure to report your injury immediately, have witnesses or picture evidence, seek medical attention immediately, make sure your healthcare provider is approved by the employer’s insurance provider, and be honest. Any inconsistencies in stories to your employer, their insurer and your healthcare provider will be reviewed and could bee seen as fraudulent.
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