If you are injured on the job, you should always work in a timely manner when it comes to making your claim for workers’ compensation. Workers’ compensation benefits are meant to cover things like medical costs and lost wages when you are unable to work due to an illness or injury caused by work. There are several reasons why a workers’ compensation claim may be denied – however, just because you received a denial, this doesn’t mean it’s the end of the road for you. Why Was My Claim Denied?
- Failure to Notify Employer of Injury:There is a statute of limitations on when you should notify your injury to an employer. The claim doesn’t actually begin until you report your injury to your employer. Each state has its own limitations, but it is typically around 30 days.
- Failure to File Claim Within Time Period: Missing the filing period for your claim is grounds to have your claim denied. The State of California has a filing period of one year since the discovery of your injury.
- Injury Occurred Outside of Employment: Were you on-site while performing work duties when the injury occurred, or off-site while pursuing duties your employer assigned to you? Then you will probably qualify. However, if your injury occurs before or after normal work hours, you may not be covered.
- Injury Occurred While Under the Influence: If you are under the influence of illegal narcotics or alcohol when injured, then you should expect your claim to be denied. This could even include medications under certain circumstances.
- Employer Disputes Injury Claim: Your employer may fight that your injury is pre-existing. They could also claim that the injury occurred outside the scope of your employment or that the injury is faked. You must prove the legitimacy of your injury.
- Your Medical Condition Isn’t Covered: Mental health issue claims are typically denied, so you must be able to link the mental issues to a specific event such as trauma. This will require clear medical evidence from a licensed psychiatrist or other doctor in the field.
- Injuries Aren’t Serious Enough For Coverage: Your injury must limit or prohibit you from completing the job duties assigned to you. You must have a doctor’s opinion stating that your injury is debilitating, and you must be able to convince the insurance company of this.
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