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Why are workers’ comp claims denied

On Behalf of | Aug 24, 2020 | Workers' Compensation

Connecticut has workers’ compensation insurance to help employees injured on the job. The injured employee files a claim much as they would if they were filing an insurance claim. In this case, however, it is a request for benefits to help cover bills, medical expenses and rehabilitation. It can even provide retraining or compensation if the impaired worker can no longer perform their previous job duties or give benefits to surviving family members if the worker died at work.

Claims are sometimes denied

Many are familiar with workers’ comp and what it does, but they may not realize that it is commonplace for the workers’ compensation carrier to deny a claim. Common reasons include:

  • Failure to notify employer: Employees must notify an employer immediately if injured on the job.
  • Statute of limitations: Separate from notifying the employer, this involves filing the claim. This is one year after the injury or three years after the initial symptom of a disease.
  • Worker’s fault: This may involve workers intentionally injuring themselves to fraudulently claim benefits, causing injury through negligence or even injury through horseplay.
  • No causal link: The injury must involve work-related activities. It also includes minor injuries on the job made worse by not treating the injury.
  • No doctor visit: An independent medical examination verifies claims. Not seeking medical help are grounds for denial or reduced benefits.
  • Claim overstates injury: Evidence would point to a less severe injury, which leads to a shorter length of benefits or reduced benefits.
  • Undetermined cause: The injury may occur at work, but have nothing to do with work. This would be something like a heart attack, stroke or seizure. A medical professional determines the cause.

Denials are not the final word

Valid workers’ compensation claims may be initially denied, but a worker can appeal this ruling. Those concerned about a potential denial of benefits, or were initially denied appropriate benefits, can appeal the process with help from an attorney who handles workers’ compensation cases. These legal professionals can help the injured fill out paperwork, meet critical deadlines, and strengthen an argument for securing workers’ benefits.