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Reasons a Workers' Comp Claim is Likely to be Denied

hand holding workers comp claim denied letterBeing injured on the job is extremely disruptive and sometimes, depending on the seriousness of the injury, it is a life-altering event. Even if you are extremely careful and follow your company’s safety procedures, accidents occasionally happen. When they do, you want the peace of mind that both you and your family will be provided for. Under Georgia’s workers’ compensation laws, you are entitled to receive benefits to help cover your financial and medical needs while you go through the healing process.

Unfortunately, there are many factors that make a worker’s compensation claim more likely to be denied. If any of the factors mentioned below apply to your claim, you may have a difficult time getting the benefits you need and deserve. Our experienced Savannah workers’ compensation lawyers can discuss your claim, identify any possible obstacles and work to help you secure the benefits you deserve.

Timing of Your Claim

If you did not report your injury immediately, your claim may be denied. Workers’ compensation insurers may believe that if you did not report an injury immediately that you were not really hurt.

According to the Georgia State Board of Workers’ Compensation, if you wait more than a month to report your injury, you may lose the opportunity to receive workers’ compensation benefits. For this reason, it is best to report the accident immediately after it happens. Your employer also has certain obligations it must fulfill after receiving notice of an injury, including carrying out an accident investigation, so it is important to help your chances of a claim by avoiding any delays in this process.

In other cases, employees may fail to report their injury until after they were fired or laid off. Insurers are likely to deny this type of claim because they may consider it a revenge claim or a way for an employee to receive compensation while unemployed.

Pre-Existing Injury

Evidence of a pre-existing injury is another common reason why insurance companies may deny a workers’ compensation claim. The insurance company may believe that you already had the injury that you are making the claim for and that it should not be responsible for providing medical treatment for this existing injury. While this is a valid reason to potentially deny a claim, if the accident aggravates or makes your pre-existing injury worse, workers’ compensation benefits may still be available.

Lack of Witnesses

Workers’ compensation insurers do not like unwitnessed accidents and may suspect fraud if a claim is filed when the accident is not witnessed. However, if you get hurt in a situation in which no one else saw the accident, there is not much that you can do about that. Simply be sure to report your injury to your supervisor immediately and inform your co-workers of the same details.

Discrepancies in Your Records or Lack of Documentation

Insurance carriers might deny a workers’ compensation claim if the employee’s statement about how the accident occurred and statements in medical records are inconsistent. It is important that the story the worker gives his or her employer, medical providers and co-workers is the same.

In other cases, the worker may not have medical records that establish he or she was actually injured or injured in the way he or she claims.

Failing a Drug Test

After filing a report of an on-the-job accident, your employer will likely require you to take a drug test. If this test reveals that you were under the influence at the time of the accident, the workers’ compensation carrier will likely deny your claim.

Refusal to Provide a Recorded Statement

Workers’ compensation insurance carriers will usually ask injured employees to provide a recorded statement about how their accident occurred. Many employees may feel uncomfortable providing this type of statement before consulting a qualified workers’ compensation lawyer. The carrier may allege that the failure to provide a statement is grounds for the denial.

Injury Due to Horseplay

If your injury was due to horseplay or play fighting, the accident may not be considered to have occurred within the scope of your employment, and your claim might be denied.

Contact Roden Law for Help with Your Workers’ Compensation Claim

If you were injured at work, it is important that you work closely with an experienced workers’ compensation attorney. A skilled workers’ compensation attorney can help guide you through the process, including assisting you in the appeals process if your claim is denied.

The trusted workers’ compensation attorneys at Roden Law can help you fight back if you are unjustly refused the workers’ compensation benefits you deserve. Contact us today to discuss the specific circumstances involved in your case.

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