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Reasons Workers’ Compensation Claims are Denied

Posted On November 10, 2016

Workers’ compensation claims can be denied for any number of reasons. The following are among the most common reasons that Chicago workers’ compensation attorneys see when a claim is denied:

The Injury Didn’t Occur in the Workplace

Unless a worker is physically located in the workplace or conducting work related tasks, the injury is not work related. For a claim to be approved, there must be a clear connection between a workers’ duties and the injury.

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Workers' comp claims denied infographic

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Notification Requirements Were Not Followed or Deadlines Were Missed
An employer must be notified of an injury as per company guidelines. This allows an employer to carry out an investigation into the injury. It is one of the first things that insurance companies and employers look for when a claim is filed.

Further, employees must file their workers’ compensation claim within the specified statute of limitations. Any claims filed outside the statute of limitations can be summarily denied.

Alcohol, Drugs, or Mischief are Involved

Employees under the influence of alcohol or drugs are not eligible to file a workers’ compensation claim. For instance, if an employee takes the company pick-up to the bar and gets in an accident.

Moreover, employees cannot file claims for accidents or injuries that are the result of “playing around” on the job. Such things as playing practical jokes, deliberately misusing equipment, or creating dangerous situations can disqualify a claim.

Receiving Out-of-Network Care

Employees are required to seek treatment from their employer’s or insurance company’s approved medical service provider. However, if it can be shown that these physicians were consulted, and another physician can provide better quality of care, then it is possible to seek and receive compensation for treatment outside the network.

Lack of Medical Records

It is crucial to seek treatment following an injury. This creates a record of the injury and its impact on an individual’s ability to perform their work- related duties. It is crucial to seek treatment and record as many facts and details as possible at the earliest possible opportunity.

Employer Disputes

Employers have the right to dispute claims made against them. This is why it is crucial to have a workers’ compensation attorney in Chicago to represent the claim. This can help protect a worker from rebuttals and disputes from an employer seeking to avoid making payments on the claim.

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