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Why Are Workers’ Compensation Claims Rejected?

Are you looking for answers because your insurance company might deny you workers compensation claim for an on-the-job injury or illness?

You may have been hurt or gotten sick while working. The first thing you likely did was consult with your personal injury lawyer in Alameda. This professional probably told you to file a claim in order to collect workers’ compensation benefits. You may have been unpleasantly surprised and disillusioned if your claim was rejected. While it is depressing, rejection of workers’ compensation claims is actually very common. This is the case even if your illness or injuries really were caused while working. After you got over your initial feelings of anger and depression, you likely wondered what you could do next. Well, the answers are discussed below.

Basic eligibility for workers’ compensation insurance

Your personal injury lawyer will tell you that there are two criteria that you must meet to qualify for workers’ comp:

1. You were an employee when you got injured. You don’t count if you are an independent contractor or are self-employed. The exception is independent contractors who are really legal employees.
2. Your employer must have workers’ compensation insurance. Almost all states in America require employers to carry workers’ comp insurance.

What happens when injuries aren’t work related?

Your lawyer will tell you that your claim will likely be rejected if your injuries weren’t on the job ones. You’ll get workers’ comp benefits only under the following two circumstances:

● You became ill or were injured while doing something to benefit your employer
● Your work caused your injuries or illnesses.

You will be covered if you were injured while on a business trip. However, injuries sustained during regular work commutes don’t qualify. You will also not qualify if your injuries or illnesses at work were intentionally caused. The same applies for injuries and illnesses that were caused by alcohol, drugs, or horseplay.

How pre-existing conditions affect workers’ comp claims

You can get workers’ comp benefits even if you have a pre-existing condition. A good example is hurting your back in a car accident and then hurting your back while lifting heavy items at work. Don’t be surprised if the insurance company tries to lower your benefits or even reject your claim stating that the pre-existing condition is largely what caused your on-the-job injury.

Minor injuries: You want to seek immediate medical attention after sustaining an on-the-job injury or illness. The workers’ comp insurance company may try to reject your claim stating that your injuries were minor and don’t need to be compensated for otherwise.

Workers’ comp deadlines: Don’t miss deadlines if you want to receive workers’ comp benefits. Also remember that the sooner you report your work-related injury or illness after your accident the better. If your claim is denied, you can always appeal with the help of a lawyer.