When Can An Employer Deny a Workers' Compensation Claim?

After suffering a workplace injury, your next step is to initiate the claims process, which includes a number of different steps. If not conducted properly, or if there is an issue regarding the claim itself, your workers’ compensation claim might be denied by your employer. Of course, not all denials are valid and employers often try to dispute claims to save money on having to pay higher insurance premiums.

Below is a list of some of the valid reasons why your employer might have denied your workers’ compensation claim:

  • You are not covered by workers’ compensation insurance: Not all workers are protected by workers’ compensation insurance, so it is important for you to understand your rights. For example, independent contractors are generally exempted from this coverage. There are also some executives who are exempt, in addition to domestic employees, agricultural workers, and individuals who might be covered under different policies. Understand your own rights and whether or not workers’ compensation insurance covers you.
  • You did not provide any notice: All injured workers are required to notify their employer of their injury or work-related illness within a specific timeframe. If you miss the deadline, it is possible that your employer will deny your claim, so make sure you report your workplace injury or illness as soon as you become aware of it or as soon as you are able to.
  • Your injury was not work-related: Workers’ compensation insurance only provides benefits for workers who sustain work-related injuries or illnesses. If an employer believes that an employee was injured outside of work, the claim can be denied and it would need to be proven that the injury was work-related. In such cases, an independent medical examination can help determine the cause of the injury.
  • Your injury was caused by intentional actions: Workers’ compensation is not a fault-based system, but it still only covers accidents. It does not cover intentional actions, so if you purposely injured yourself in an attempt to obtain workers’ compensation benefits, your claim will be denied and considered fraudulent.
  • Your injury involved willful negligence: If you were willfully negligence when you sustained your workplace injury, your claim might also be denied. For example, if you were intoxicated or under the influence of drugs, your employer might use your actions as a defense to deny your claim.
  • You did not seek medical treatment: In order for you to have a valid claim, you need to have an injury, and you must have sought treatment for that injury. If you visited a doctor, but did not attend an independent medical examination from a doctor of your employer’s choosing, this could also serve as grounds for a denial of your claim.
  • Your injury is not as severe as you claimed it to be: Not all injuries require a worker to take time off from his or her regular job duties, so if yours is not as severe as you claim it to be, your benefits are likely to be reduced or denied.

If you believe that the reason why your employer denied your claim was not valid, then you should appeal your workers’ compensation claim. If you did not previously hire a workers’ compensation attorney, make sure you do so now to ensure that you do not miss out on these critical benefits.

Workers’ Compensation Attorneys in Cobb & Marietta County

If you suffered a workplace injury and your claim was denied, you can file an appeal to this denial. However, you are going to need skilled legal representation on your side. At Chestnut & Beller, our workers’ compensation attorneys in Cobb and Marietta County are backed by over 60 years of combined experience and are dedicated to protecting the rights of injured workers. We will do what it takes to ensure you are able to receive the benefits you need to assist you during this difficult time.

Get started on your workers’ compensation case today and contact our law office at (770) 285-5542 to request your free initial case evaluation with one of our knowledgeable attorneys.