Common Reasons Why Your Workers' Compensation Claim Was Denied

If you have suffered an injury due to a workplace accident in Oklahoma, you are eligible for workers’ compensation benefits through your company. However, it is not uncommon for an employer or their insurance company to deny workers’ compensation claims.

If your claim was denied, you need to know exactly why that decision was made. In most cases, an explanation can be found in the denial letter. While you could be denied due to eligibility issues, there are many cases where the insurance company made an error in denying your claim.

The following are the most common reasons for a denial of workers’ compensation benefits:

  • You failed to report the injury immediately – As soon as the accident occurred, you need to report your injury to your employer or manager right away and fill out an accident report in order to begin the claims process. Workers’ comp insurers are skeptical of cases where the accident isn’t reported immediately, assuming that the injured party isn’t really hurt.
  • Your employer doesn’t believe your injury is work-related – Your employer may claim that you weren’t working or performing your job duties when you suffered the injury. This is often the case when injured party travels for work, commutes between job sites, or is runs errands at the supervisor’s request. Injuries sustained during an employer-sponsored event or during lunches and breaks are not covered by workers’ compensation.
  • There were no witnesses – Insurance adjusters often dispute claims when no witnesses are involved. As long as you report the incident immediately and tell each person the exact same story about how you suffered your injury, having no witnesses should not be used against you.
  • You didn’t seek immediate medical attention – Not only must you report your injury right away, but you also need to visit a doctor and obtain medical treatment in order to receive workers’ comp benefits. Without any medical records of the incident, the insurance adjuster will assume the injury was not serious. Furthermore, if there is a discrepancy between your accident report and your medical records, it will harm your case.
  • You were under the influence of drugs – If medical records indicate the presence of illegal drugs in your system, you should expect your claim to be denied.
  • You filed a claim after you were fired or laid off – If you delayed getting around to file a workers’ comp claim but either got fired or laid off before you could, insurers typically assume that you are out for revenge.
  • You refused to provide a recorded statement to the insurance company or sign medical authorizations – Insurance companies will ask if you provide a recorded statement which describes the accident and your injuries. However, providing such a statement may not be in your best interest. The same goes with refusing to sign medical authorizations since insurance companies may invade your privacy and gain access to records not related to the work injury. If the insurer pushes you to provide a recorded statement or sign medical authorizations, it is important to discuss the issue with an attorney.

If the insurance adjuster denies your workers’ compensation claim, you can still file an appeal with the help of a skilled lawyer. It is important to gather as much evidence as possible which supports your claim.

If your workers’ compensation benefits were denied in Oklahoma, contact our Norman workers’ comp attorney at the Law Offices of Keith J. Nedwick, P.C. today.

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