What Does a Workers Compensation Denial Mean?

When you are counting on receiving workers compensation benefits, a denial can be devastating. After all, you may have no other way to pay for your medical bills and costs and you may not be able to support yourself or your family if your work-related injury has caused you to be temporarily or permanently disabled.  Fortunately, a worker’s compensation denial doesn’t mean that you are out-of-luck when it comes to receiving benefits. In many cases, with the help of an experienced worker’s compensation attorney, you can successfully appeal the denial to receive the benefits you deserve.

Reasons for a Workers Compensation Denial

There are many different reasons why a workers compensation denial might occur, and it is important to understand why you were denied so that you can correct the problem during the appeals process.

One reason that a claim may be denied is if an employer does not believe an injury was work-related. This is most common in cases where the injury is either a repetitive stress injury or an illness developed due to exposure to toxins at work. Since these things cannot be traced directly back to one specific incident, such as an accident at work that immediately broke your arm, employers sometimes believe that a worker doesn’t have sufficient proof to get benefits.  An employer can also indicate that the employee wasn’t actually doing something required for his job when the injury happened, which can also result in a benefits denial.

If an employer doesn’t believe the injury is work-related, then you and your workers compensation attorney will need to gather detailed evidence to tie the injury, illness or condition directly back to the performance of work tasks. For instance, if the injury is a repetitive stress injury to the hands similar to carpel tunnel, then you would want to gather evidence showing how often you had to do repetitive motions with your hands at work and have a doctor provide a statement (and medical evidence) attesting to the fact that these repeated work motions were the cause of the condition.

An employer can also try to argue that an employee was in violation of company policy or otherwise doing something to disqualify himself from benefits. It is important to note that workers comp is a strict liability system, which means that an employer can be responsible for work-related injuries even when they weren’t negligent and even, in some cases, when the employee was. If an employer argues that the employee should be disqualified because of his behavior, the employee will need to show it was egregious, such as coming drunk to work.

Finally, an employer can also deny a workers comp claim because of some technical problem with the application. An employee, for example, might not have filed the application on time and the employer may be claiming it is time-barred. In cases like these, an experienced workers compensation lawyer can help to correct the defect with the application whenever possible so that you can get the benefits you deserve.