Common Reasons Workers' Comp Claims Are Denied

From 2015 to 2016, people filed 152,082 workers’ comp claims, and about 14% of them were rejected. If there were approximately 2.9 million nonfatal workplace injuries and illnesses reported in 2015, how could so many claims go un-filed? Additionally, why would so many of the small number of requests be rejected at all? Workers are hesitant to ask for workers’ comp out of fear their employer will retaliate against them or out of concern their reputation may be compromised by not “grinning and bearing it.” For those that do submit the paperwork, take a look at the most common reasons their rights might be denied.

The Claim Wasn’t Filed on Time

One of the most prevalent reasons a workers’ comp claim is denied is because it was filed too late. According to Florida law, you have 30 days to submit your paperwork after an accident or after your doctor tells you you’re suffering from a work-related illness. After 30 days, your employer or insurance company can deny your claim based on missing the deadline.

Your Injury Isn’t Covered

Some illnesses and injuries aren’t covered by workers’ comp. Scrapes and bruises, or simple problems that could be remedied by first-aid care, are not eligible for compensation. Likewise, average, day-to-day stress wouldn’t be included. However, if your injury is small but chronic, such as headaches, and was triggered as a result of exposure to a harmful chemical at work, you would be eligible for compensation.

Claims for injuries sustained “off the clock” are also likely to be rejected. For example, if someone crashes into you on the drive to work, auto insurance, not your employer’s workers’ comp, would be responsible for paying for medical expenses and disability. However, if you are paid to drive to a client’s house or to make deliveries, any injuries acquired during the trip would be covered.

Your Employer Disputes It

Many businesses will not want to cover your medical care and will deny the workplace had any liability in your accident or illness. Often, an employer and his or her insurance company will look for any reason to reject your claim, including that your injury is not severe or that it was the result of an accident that occurred off company property. They will send you a claim denial letter, which you can later take to your attorney in order to appeal the decision.

No One Saw the Incident

If you were the only person who witnessed your accident, the insurance company might use the lack of other observers as a reason to doubt your credibility. After all, if no one saw the mishap, how do they know you didn’t try and cheat the system for a free ride? While there may be no security cameras or coworkers around when you are injured, if you report what happened as soon as possible to colleagues and your supervisor, your claim is less likely to be denied on these grounds.

Workplace injuries can be debilitating, even deadly. Make sure your rights are protected if you think your claim might be denied by an unscrupulous employer or insurance company. Contact one of our Miami workers’ compensation lawyers for a free consultation. We have more than 100 years of combined experience with these kinds of cases.