What happens if workers comp claim is denied

Of course, it is always advisable to report your injury immediately, as this will only help your case. If you report an injury outside of these deadlines, you will be unable to collect benefits. No one witnessed your accident.

Whether your witness was a coworker or a surveillance video, any proof that can verify how you became injured can help your case. If you know that your accident had no witnesses, it should encourage you to report your injuries to your employer immediately, and get prompt medical attention.

Nor is the employee legally required to give the insurer a recorded statement. If the insurer asks for a statement, that is usually a sign that the insurer has a problem with the case. If the employee gives the statement, the insurer is still probably not going to put that employee on workers' compensation benefits. Insurers will also generally ask the employee to sign medical authorizations that will allow the insurer to write directly to the employee's health care providers to get the employee's medical records and bills.

Again, the employee generally has no legal obligation to sign medical authorizations. However, insurers don't like when employees do that.

They don't trust injured employees. Insurers like to get the medical records on their own. That way they can be sure that they get a complete file, not one that has been cherry-picked.

The problem with medical authorizations is that sometimes the insurer will invade your privacy and get medical records that do not relate to the work accident. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site.

The attorney listings on this site are paid attorney advertising. In some states, the information on this website may be considered a lawyer referral service. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. This is a classic rock-and-a-hard-place scenario. Providing a statement is unlikely to clear up those doubts, but refusing can be used as a reason to deny or delay benefits.

If you sprain an ankle slipping on an unmarked wet spot, or you fracture a femur stumbling over unsecured cables, and no one was around to see it — did it really happen? This is not a philosophical question. It is a ready line of defense for the insurer to deny your claim.

Your defense is to be proactive: Report your injury to coworkers and your supervisor immediately. Make sure of the details, and be certain to tell everyone exactly the same thing about the circumstances involving your injury. Witnesses or not, legal experts recommend preserving the scene of the accident on your smartphone. Employees injured while under the influence of drugs or alcohol have an uphill climb.

In some states — among them Texas, Florida, Ohio, and North Carolina — employers and insurers can assume an injury was nonoccupational not covered if drug testing reveals high levels of alcohol or drugs.

Such defenses are not slam-dunks. Much depends on when the drug test is taken. Because such situations can be extremely nuanced, you will want an experienced workers comp lawyer to argue your injuries occurred within the course and scope of your job. If your workplace injury was the direct result of horseplay or a practical joke you initiated or in which you willingly participated , your claim likely will be denied. If, on the other hand, you simply happened to be at the wrong place at the wrong time, or you were the target of extracurricular hijinks gone wrong, you will be eligible for benefits.

About the author Tom Jackson Tom Jackson won dozens of national awards as a columnist for newspapers in Washington, D. His writing has spread from business to politics to sports with an emphasis on community issues. Tom splits his time between Tampa and Cashiers, N. Tom can be reached at tjackson workerscompensationexperts. Disclaimer: Workers Compensation Experts is not a law firm or lawyer referral service.

The content and materials presented on this site are for informational purposes only. We do not provide legal advice, and no communication between you and Workers Compensation Experts should be considered legal advice. No attorney-client relationship will be formed by the use of the site. The information on this site may be considered a lawyer referral service in some states. For specific information related to your state, reference the Terms of Use.

Use of our services are governed by our Terms of Use and Privacy Policy. Here are a few things to do when your claim is denied: First, speak with the insurer who denied your claim. Talk to a workers compensation attorney right away. File an appeal within thirty days of receiving your denial letter. Get your documentation together to bring to the upcoming hearings.