Why Would a Workers’ Comp Claim Be Denied?

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Employees injured on the job depend on financial compensation to cover their medical bills and make up for lost income. Therefore, getting a workers’ comp claim denied can feel like a punch in the gut.

To prevent this from happening to you, keep in mind the common reasons insurers deny these claims. Fortunately, some of the reasons point to preventable errors and circumstances.

Paperwork Errors and Delays

Perhaps one of the most avoidable reasons relates to clerical error on the part of the person filing. For example, missing a filing deadline by one day will likely result in denial. Submitting paperwork that is missing information will also get your claim rejected. If you are not detail-oriented, a top lawyer in Cincinnati specializing in workers’ compensation can help you with the paperwork and filing.

Your Provider Is Not Certified

The Ohio Bureau of Workers’ Compensation (BWC) requires that any provider you go to for your work-related injury must be BWC-certified. Seeing any other doctor or therapist will also get your claim denied.

Some employees opt for using their employers’ physicians. However, you have the right to choose your own doctor as long as they have BWC certification. You can go to the BWC’s website and search for qualified doctors so that you do not jeopardize your coverage. A worker’s comp attorney can also recommend a qualified provider.

Running into Legal Challenges

You never know when a legal snag could interfere with an otherwise legitimate workers’ comp claim. State laws change frequently, and without the advice of a lawyer versed in workplace injuries, you might not be aware of recent legislative changes. Also, because each work-related injury or illness is unique, some legal issue with your claim might hold up the process.

Your Injury Is One of the Types Not Covered

Being injured at work might not necessarily qualify you for worker’s compensation. For instance, you may get hurt on the job site, but it might not have happened within the scope of work or due to working conditions. The BWC will deny your claim for worker’s comp if you:

  • Got hurt after you left your employer’s property, such as going home at the end of a shift
  • Were intoxicated
  • Were careless or engaged in horseplay
  • Purposefully harmed yourself

You Have a Pre-Existing Medical Condition

Your medical history might be to blame if the BWC denies your claim. If you are on record for treating a similar injury in the past, an insurer could view that as a pre-existing condition. Specific medical tests, MRIs, surgeries, or other treatments or diagnostics could pop up as red flags for anyone processing your claim. These things could lead them to conclude that something else besides the workplace incident contributed to your injury.

You Are an Independent Contractor

Only hourly employees get workers’ compensation coverage through their employer. If you work on contract, you are probably not eligible for benefits if you get hurt. This can come as a shock to some individuals who believe they are classified as hourly employees. Unfortunately, some companies classify workers as contractors to save money on insurance premiums. As a precaution, before you take on a new job, find out your employment status.

There are many reasons why your claim for workers’ compensation may be denied. If this has happened to you, you can still appeal the decision with the help of an experienced workers’ comp attorney. If you believe your denial was unjustified, you have the right to legal representation to fight for compensation.