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3 common reasons for a workers’ compensation claim rejection

On Behalf of | Apr 18, 2024 | Workers' Compensation

Becoming ill or getting hurt can seriously affect your life and ability to work. You may need time off, medical treatment and/or rehabilitation, all of which can cut deeply into your finances as well.

If your illness or injury results from your workplace duties or conditions, you may be eligible to file a claim for workers’ compensation through your employer’s insurer; however, this does not guarantee the receipt of benefits. Insurers deny claims for a number of reasons.

1. Slow reporting

It is important to report injuries and sicknesses as soon as you possibly can because not doing so raises suspicions about the cause and timing of the incident. There are also deadlines, and your reporting to your employer is not the end of the information chain. Your boss has to similarly report to his insurance company to get the ball rolling.

2. Pre-existing conditions

If you have a pre-existing condition, the insurer may try to claim that your injury or illness is merely an extension of that rather than a work-related one. It is important to obtain proper medical treatment and a diagnosis to show that it is not or that any exacerbation can be directly related to your work.

3. Contributing behavior

When an injury occurs because of misconduct or violation of company policies, it disqualifies you from workers’ compensation eligibility. Examples of such behavior include horseplaying, disregarding safety precautions and being intoxicated.

Workplace injuries and illnesses are not uncommon, which is why the law requires workers’ compensation. Claim denials are not uncommon either, and they do not mean that this is the end of the road. You have options to appeal the rejection.