6 Reasons Your Workers’ Compensation Was Denied

March 14, 2020 | Accidents,Workplace injuries

Anyone who gets injured at work should be able to count on workers’ compensation insurance to cover their medical bills and lost income. The workers’ compensation insurance system is a “no-fault” system, meaning that the injured employee should be able to get coverage regardless of who was at fault for the injury. Unfortunately, there are times when the employer or the workers’ compensation insurer denies a claim. Here, we review the most common reasons for a workers’ compensation claim denial.

Missed deadlines

Every state has workers’ compensation filing deadlines. In most cases, an injured employee is required to tell their employer about an injury within a certain amount of time after an incident. In Washington, an injured worker must apply for workers’ compensation benefits within one year after an injury occurs or two years from the discovery of an occupational illness (cancers, respiratory illnesses, etc.). However, it is recommended that an injured worker report the incident to their employer as soon as possible so that a workers’ compensation claim can get started.

Disputes about whether the injury is work-related

An employer may claim that you were not working at the time an injury occurred. In general, workers’ compensation covers any injury that an employee occurs while operating within the scope of their work-related duties. This can become complicated if there is a dispute about whether or not the employee was working when the injury occurred, including if an injury happened during an unpaid break, while traveling in a company vehicle outside of regular business hours, etc.

Not seeking medical attention

In order to be eligible for workers’ compensation insurance, the injured party is usually required to seek medical treatment. The employer may also require that the injured worker receive an independent medical examination for my doctor of their own choosing. Failing to receive medical treatment or to receive the independent medical evaluation could result in a claim being denied. Injured workers should also continue all treatment programs and attend all follow-up doctor visits in order to receive continued workers’ compensation insurance until they are recovered.

The condition does not meet state guidelines

Injured workers need to know whether or not their state has any special restrictions on workers’ compensation claims, particularly for cumulative trauma injuries or psychological conditions caused by the workplace.

Claim filed after you left the job

Workers’ compensation insurance carriers may deny claims that are filed after an employee is fired, laid off, or quits their job. However, an injured worker may have a good reason for filing after they have left their job. In some cases, an employee may actually be fired in retaliation for reporting their workplace injury (which is illegal). In other cases, the injured worker may not have realized they were injured until after they left the job. Remember, workers’ have up to a year to request workers’ compensation for any injury (or two, depending on the type of injury).

Willful negligence or intentional actions

While the workers’ compensation system is generally no-fault, a claim may be denied if the injured worker’s willful negligence or intentional actions caused their injury. The employer or insurance carrier may use these actions as a defense for their claim denial. For example, a worker injured while horse playing may be barred from receiving workers’ compensation insurance.

If you’ve been injured in a workplace accident and need assistance, contact our Seattle workers’ compensation attorney today.