Having your workers compensation claim denied can come as a shock. You may even feel betrayed. After all, you put a lot of effort into your job. When your company refuses to take care of you when you're injured in the course of your job duties, it's not only a financial blow, it's an emotional blow as well. But a denial is not necessarily the last word. Whether intentionally or not, workers compensation companies sometimes incorrectly deny claims. Take a look at some of the most common reasons for workers compensation claim denials, and find out what you can do if it happens to you.
You Missed the Deadline
As with any insurance claim, your workers compensation claim is subject to deadlines. You have a limited amount of time to report the injury to your employer, and then once you report the accident or injury, your employer has to report the injury to their insurance carrier within a certain time frame. The time frame that you'll be dealing with varies by state – for example, in California, employers have five days to report the injury to the insurance carrier. If they don't, then the carrier may deny the claim and you'll be forced to take your employer to court to be paid for your injuries.
In most cases, the safest course for you as a worker is to report any injury in writing to your employer immediately. Even if you're not sure of the deadline in your state, you can be sure you're protected as long as you don't wait to report any accident or possible injury.
The waters can get murky when your injury is the result of a repetitive action or work condition. Not all injuries occur as the result of a single incident – a condition like carpal tunnel or an illness caused by repeated exposure to toxic chemicals may take time to manifest. In that case, your best bet is to report the injury as soon as it causes you to miss work, or as soon as a doctor tells you that you've developed a problem.
Your Doctor's Report Doesn't Match Your Accident Report
When you file a workers compensation claim, your employer's insurance carrier will investigate your claim. If they find discrepancies in the course of their investigation, like a doctor's report that indicates that your injuries were less severe than you're representing them to be, they're likely to deny your claim, or at least hold it up temporarily while they sort out the discrepancy.
Often, this happens because the full extent of an injury is not immediately apparent. A head injury, for example, may look like a simple concussion at first. Further testing, or the emergence of new symptoms, may reveal a more serious condition, like bleeding in the brain. Doctors don't necessarily test for every possible condition in the first emergency room visit. Often it takes time to assess the full extent of the injuries.
In many cases, a denial of this type can be overturned simply by providing updated medical information to the insurance company. In any case, it is normal for some injuries to progress over time, and your legitimate claim shouldn't be denied because of a discrepancy of this kind.
You Had a Positive Drug Test
In many cases, workers are expected to submit to a drug test immediately following any on the job accident. Even if you're not required by your employer to take a drug test, doctors may need to administer one in order to determine the proper treatment for you. A test that indicates the presence of prescription narcotics or recreational drugs is a common basis for denying workers compensation claims. The insurer may claim that your injury was caused by your intoxication and is therefore not your employer's responsibility.
There are many reasons why a drug test may come back positive. You may have already been under a doctor's care, and have a legal prescription for a particular drug. Your blood or urine samples may have been contaminated or your results may have been misinterpreted. In some cases, a legal, non-narcotic substance (like poppy seeds) may produce a false positive.
If you think that your claim was wrongly denied because of a drug test, you can take one of several approaches. You may be able to retest. You may be able to show that your sample was mishandled or that chain of custody was lost, casting doubt on the results of your drug test. You may even be able to successfully argue that the positive drug test is irrelevant. There is a precedent for that argument – in Louisiana, a waitress was granted workers compensation benefits despite a positive drug test after a judge determined that the drugs in her system were not a contributing factor in her accident.
The important thing is to realize that a denial is not necessarily the end of the line. If you feel that you were denied workers compensation benefits unfairly, or even if you're not sure whether or not you should have been denied, your best course of action is to consult an experienced workers comp lawyer in your area for advice. Don't give up on the benefits that you deserve.
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22 December 2014
It can be hard to know what to do to protect yourself legally in the immediate aftermath of a car accident. You’re liable to be disoriented or in shock, you may be injured, and you’re surely worried about your passenger or the other driver. At least, that’s how I felt. The thing is, the things you say and do in the immediate aftermath of an accident may affect a legal case later. Depending on who’s at fault and what the laws are in your state, you may want to sue the other driver for damages, or you may find yourself being sued. My blog is designed to give you tips for a car accident lawsuit, no matter which side you find yourself on.