Finding out your workers’ compensation claim is denied can be incredibly frustrating, especially if you were initially approved for benefits. Most denials come down to one of two factors — either the insurance company does not believe your injury was related to your employment, or it refuses to pay for certain benefits such as medical procedures you need or extended time off. Here are more of the most common reasons why workers’ compensation claims are denied.
Workers’ compensation covers any injury, illness, or death that arises out of or in the course of employment. This means that your injury must be directly related to your normal job duties. Many claims are denied when an injury does not meet the policy’s definition of a covered injury or illness, even though you may think it is work-related. For instance, if you took a break from your normal tasks to do a private errand which resulted in an injury, you won’t receive benefits.
Medical evidence is one of the most important parts of a workers’ compensation claim. That typically includes medical records, test results, doctors’ notes, and any other related documentation. Your employer’s insurance company will thoroughly examine the medical evidence before determining if your claim is valid. If there is a lack of medical evidence or proof that the injury isn’t serious enough, they may suspect fraud and deny your claim.
Witness testimony is also vital in workers’ compensation claims and often a reason why they are denied. If there are no witnesses or video footage, it is only your word and the available medical evidence that the insurer or employer must rely on. When this is the case, you must be consistent in the details of the incident and work with medical experts who can confirm your story. If your claim is lacking in medical evidence to support it, your employer may use the fact that there were no witnesses as an excuse for denial.
When an insurance company argues that you are responsible for a workplace injury, it is most often because you ignored safety regulations. For example, claims will typically be denied if the injury was caused by intoxication (alcohol or drug consumption), intentional violence, horseplay, ignoring workplace rules such as wearing a hard hat, etc. Similarly, if you deliberately injure yourself, your odds of receiving benefits are slim.
A pre-existing condition can be used as a reason for an employer or insurer to refuse a claim. For instance, if you have a limp in your leg that is made worse after a slip-and-fall accident. It would then be up to you to prove how the worsening of your limp is related to the accident and not the pre-existing injury. In general, you are still entitled to benefits if a workplace accident makes a pre-existing condition worse.
Many workers’ compensation applications are turned down simply because they are late. If you have suffered a work-related injury in Nevada, you must report it to your employer within seven days, and a claim for compensation must be filed within 90 days. Legally, you can still file a claim, but it may not progress if you miss these deadlines.
Once a claim is denied, you can counter by filing a Request for Hearing – Contested Claim within 70 days of the decision. There you can present your evidence from qualified medical experts showing how your injury is genuine and serious. However, it is important to get the help of a workers’ compensation lawyer in Las Vegas to assist you and ensure you obtain the benefits you deserve.
If your workers’ compensation claim has been denied, a skilled Las Vegas lawyer at Harris & Harris Injury Lawyers will help you through the complex appeals process. Contact us online or by calling (702) 384-1414 to schedule a free initial consultation.
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