5 Most Common Reasons Why Workers’ Compensation Claims Are Denied

It can happen in the blink of an eye. An accident on-the-job from a fall, from machinery, or any accident while you were technically on the clock. Some workers develop an occupational disease from their exposure at work.

They all count as a claim against your workers’ compensation benefits.

Alabama employers, with five or more workers, must take out insurance to protect themselves in case their employees are injured. The employer then has limited liability from a lawsuit.

You need to make a claim but what should you know in advance to make sure it is successful the first time?

First, let you employer know you are injured.  You have up to two years to file a claim from the date of the injury, however, that is fraught with problems.  If you are fired during that time, the reporting may look like revenge. You are much more likely to have a successful workers’ compensation claim if you report within days of your accident or injury, if not immediately.  

Not reporting in a timely manner is one of the top five reasons your workers’ compensation claim may be denied. The legitimate question could be asked – why didn’t you report an injury you suffered at work? Wasn’t the injury bad enough?  Were you on the clock?

It cannot be emphasized enough that timely reporting is essential.

Other reasons a workers’ comp claim may be denied include:

• No witnesses – Your injury was not witnessed by anyone on the job. How then can the workers’ compensation system be sure that it happened on the job and not before work?
  
  
• You were not working at the time of the injury – Maybe you were picking up dry cleaning during your lunch hour, which is not compensable. However, if you were picking up your bosses dry cleaning and it was something you were directed to do, that is a different story and you would likely be eligible for compensation.

• You refused to use safety equipment. For example, a guard is part of a saw assembly that keeps fingers from encountering the blade, however you don’t like using the guard. It’s inconvenient and takes extra time to remove and replace it and you didn’t use it at the time of the injury. Failure to use proper safety equipment could severely impair your workers’ compensation claim.
   
• Your medical report may not match your description of the accident. The insurance company may question how an accident actually happened if there are inconsistencies in your story when compared to the medical evidence. How does the insurer know this wasn’t a preexisting condition?  When you describe the accident, you need to be very specific “how” it happened.  “I fell” is not enough.  When you say I stepped around the work site but fell into an excavated pit that was 10 feet deep and was covered with planks of wood at the time, that is much more specific.
  
  
• You may have had illegal drugs or alcohol in your system. This goes without saying, even if illegal drugs don’t alter your perception and you are able to carry on as if you were not on drugs, the presence of illegal drugs in your system will greatly contribute to a denial of your claim.

You also want to make sure that you follow the doctors’ designated treatments.

If you are denied a workers’ compensation claim in Alabama, you are required to file a lawsuit in state court. You must file what’s called a “complaint” and the other side will submit its answer. Both sides then gather evidence to support their respective claims.

Unfortunately, the state does not have a court to deal specifically with hearing workers’ comp disputes. It is at this time that you will need the expertise of someone familiar with Alabama workers’ compensation laws.

The Alabama Department of Industrial Relations has a workers’ compensation division you can access if you need to have a third party resolve any non-medical disputes about the benefits you believe you should receive.

There is also an Ombudsman program under DIR that can mediate disputes about medical benefits for injuries received on-the-job.

Contact Attorney Chip Nix at 334-203-6669 for a free consultation. He will help you file a workers’ compensation claim that is approved the first time.