Why Can a Workers’ Compensation Claim Be Denied?

Why Can a Workers’ Compensation Claim Be Denied?

On Behalf of Rosenthal, Levy, Simon & Sosa | July 29, 2022 | Workers' Compensation

You are probably looking to pursue your workers’ compensation benefits if you got injured at your job or developed a condition due to your job duties. However, it is crucial to note that the workers’ compensation insurance system functions like any other insurance policy, which means that there are specific circumstances under which your WC Claim may be denied.

Here are the most common reasons for workers’ comp claim denials and what you must do to uphold your legal rights.

Your Employer or Workers’ Comp Insurer is Contesting Your Alleged Workplace Injury

They might say that you didn’t get injured at work, that you were engaging in some type of misconduct when you got injured at work, or that you were not working for your employer when you sustained your injury. But regardless of why your employer or insurer is disputing your claim, the burden of proof is on you to present solid evidence that will support your workers’ compensation claim.

Perhaps you need to provide more medical evidence or witness testimony about the events leading up to the accident. If your treating physician has stated that your injury or condition was work-related, but the insurer is still disputing your claim, it would be best to obtain another physician’s opinion.

You Missed The Deadline For Filing Your Workers’ Comp Claim

You must inform your employer about your illness or injury immediately to receive your workers’ compensation benefits. Take note that in Florida, the deadline for reporting a work injury is within 30 days of the incident, or you risk having your claim denied.

Your Injury or Condition Does Not Meet The State Guidelines

For example, if you got injured because of intoxication or under the influence of drugs that your doctor did not prescribe, you won’t be eligible for workers’ comp benefits. Likewise, your injury will not be covered if you intentionally tried to hurt yourself. Additionally, mental anguish arising from work-related stress isn’t a covered condition under the Florida workers’ comp rules.

You Filed Your Workers’ Comp Claim After Leaving Your Job

Insurance companies typically deny WC claims that were filed after an employee quit, was laid off, or fired. But you may have a valid reason for the timing of your filing. Perhaps you sustained an injury the day before you left or were fired, or you got fired because you reported a work-related injury, which is illegal, by the way.

Consult With an Experienced West Palm Beach Workers’ Compensation Attorney Now

Unless your employer or workers’ comp insurer denied your workers’ compensation claim because of a simple error that can be resolved easily, you should discuss your claim with a West Palm Beach workers’ compensation attorney right away. Your attorney can also help you figure out whether appealing your claim would be the most suitable option for you.

Reach out to Rosenthal, Levy, Simon & Sosa today to schedule a free case review with our West Palm Beach workers’ comp attorney. You can call 561-478-2500 or send us an online message for more details.