Employees making legitimate workers’ comp claims are sometimes denied. There are many reasons why an insurance company may attempt to deny benefits. Sometimes the companies have understandable reasons for denying claims; other times the companies lack any justifiable basis for denying benefits and the employee needs an attorney to protect their legal rights. The following are five common reasons for denying a workers’ comp claim.
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Injury is not work-related
If an employer believes the injury occurred while the employee was away from work or happened when the employee was no performing work-related duties, they will automatically deny the claim. Companies will also deny claims they believe are due to preexisting conditions. Even if someone has a preexisting condition, they may still have a legitimate claim. A personal injury lawyer can advise them of the best course of action.
Lack of medical evidence
Companies may attempt to dismiss injuries as fake if there are no witnesses to the injury or the employee did not report the injury right away. Insurance company doctors get ongoing business from the companies by saying what the insurance company wants them to say. A personal injury lawyer can help compile and present the evidence needed for a solid case.
Waiting too long to report the injury
All injuries and work-related illnesses should be reported right away. The more time that passes from injury to filing a claim, the more likely it is the company or insurance company will deny the claim. Waiting can also make it more difficult to prove the injury occurred at work and not from some personal activity.
Going to the employee’s own doctor
For medical bills to be covered by workers’ comp, the employer and insurance company may require the injured worker see a doctor within the insurance network. A personal injury attorney can advise individuals who feel the insurance company’s doctor is minimizing the severity of their injury or not providing a proper diagnosis.
Incomplete or improperly completed paperwork
Before paying benefits on any claim, insurance companies have the right to review the employee’s medical history, all medical records associated with the claim, and the injury report. To prevent insurance companies from falsely claiming they have not received all necessary paperwork, injured employees can send the information to the Illinois Workers’ Compensation Commission in addition to the insurance company. This ensures there is a file of all records available to all parties in the claim.
