So you filed a workers’ compensation claim and the insurance adjuster has been consistently questioning its validity. It’s not uncommon for workers to have the validity of their work injury claims questioned even if they are legitimate.
We’ve had several clients walk into our Kevin P Landry New Bedford offices looking to hire a workers’ compensation attorney to help them enforce their rights. Through the many cases that we’ve handled, we’ve noticed that insurers deny injury claims because of seven reasons which we will be addressing here.
Reasons Why Your Workers’ Compensation Claim was Denied
1. You are not entitled to Workers’ Compensation Claim
In order to qualify for workers’ compensation benefits, you must be an employee. People who are not entitled to workers’ compensation benefits include interstate railroad workers and crew members on vessels. They are the only workers allowed by federal law to file a personal injury lawsuit against the employer. Independent contractors are also not entitled to workers’ compensation.
2. You Refused to Sign Medical Authorizations or Give a Recorded Statement
Workers’ compensation insurers like telling injured workers to give a recorded statement describing their accident and injuries. While this might sound harmless, it often puts employees in a difficult position.
If you give out a recorded statement without the help of a workers’ compensation attorney, you’ll only be damaging your case. When the claims adjuster asks for a recorded statement, it’s because they have a problem with your case. If you give out a statement, the claims adjuster will not put you on workers’ compensation benefits and if you don’t give out a statement, they will still tell you they won’t put you on workers’ compensation benefits. So aren’t you better off not giving out a statement?
In addition, you are not obligated to sign medical authorization forms that will allow the adjuster to gain access to your medical records. You are, however, obligated to give the claims adjuster medical records and bills related to the accident and even then, you don’t need to sign anywhere, you can give them the records yourself.
Insurance adjusters don’t like when injured employees get the records themselves since most of them are notorious for handing over incomplete records. On the other hand, injured employees have a problem signing medical authorization forms because insurers are notorious for accessing medical records that have nothing to do with the accident.
If you feel the insurer is cornering you or pushing you to sign the forms, contact your New Bedford workers’ compensation attorney and let them deal with the insurer.
3. Your Claim Was Filed After You Were Fired
We’ve dealt with clients who never filed for workers’ compensation after their work related accident only to file it when they heard they were being fired or after they were fired. The problem with waiting for this long is that insurers and even the workers’ compensation judge will assume you are on a revenge mission. This is why we always advise injured workers to file a work injury claim as soon as they are able to.
4. Your Records Show You Were Intoxicated
If you were intoxicated at the time you were involved in an accident, you will most certainly have a difficult time trying to convince them that you should be paid workers’ compensation benefits. Most employers require injured employees to take a mandatory drug test once they get to the emergency room. Nobody wants to have to pay benefits to someone who got into an accident because they were intoxicated.
5. Your Initial Medical Records and Your Accident Report are Inconsistent
If everyone involved in your case has a different version of how the accident happened, the claims adjuster will most likely deny your claim. Make sure that you tell your supervisor, your employer, your doctor and the claims adjuster the same version of what happened. Don’t forget that it also has to match what the other employees saw happen during the accident. If there is a discrepancy between your medical records and your accident report, the claims adjuster will assume you are lying about the accident or the injuries.
6. You Waited too Long to Report the Accident
Claims adjusters assume that if you don’t report your accident immediately or seek medical attention immediately, then you weren’t hurt. You are required to report your work related injury in as little as seven days. If your injury might cause you to miss work, report it immediately to your supervisor and fill out the work accident report. Don’t wait too long before reporting your accident or you might miss your chances of getting benefits when you really need them.
7. Nobody Witnessed Your Injury
You don’t need to worry if nobody witnessed your accident but insurers typically don’t like dealing with unwitnessed injuries. They question if truly your accident was an accident or if it was self-inflicted. However, just because your accident wasn’t witnessed by anyone shouldn’t deter you from reporting it immediately to your supervisor. Just make sure you tell everyone exactly what happened.
Take the Necessary Steps to Protect Your Workers’ Compensation Claim After Your Accident
If you suffer a work related injury or illness, workers’ compensation may be your only means of recovery. This means you cannot file a personal injury lawsuit against your employer.
We wrote a post that discusses the difference between a personal injury lawsuit and a workers’ compensation claim and why you cannot file the two.
You should immediately report a work related injury to your supervisor no matter how small it is. Sometimes what we consider small injuries can prevent us from doing our jobs well. This means losing wages.
Making a successful claim through workers’ compensation is much easier than filing a personal injury lawsuit.
To find out more about why your claim was denied, contact one of our workers’ compensation attorneys in New Bedford by dialing 508-999-0800 today for a free initial consultation. Alternatively, you can come to our New Bedford offices or we can come to wherever you are upon request. Let us help you get the justice you deserve.