Why are Workers’ Compensation Claims Denied?

Insurance firms routinely reject applications for workers’ compensation. Insurance industry experts predict that 25% of initial claims for workers’ comp are turned down. Insurers often forward denials hoping the claimant will give up. With insurance companies such as Cerity, one can ensure that all compensation details are in place. 

Knowing the most common and legally sound reasons why insurance companies deny workers’ comp claims can help you prepare for any disputes and denials you may face.

Here are a few reasons why your compensation claim could be denied; 

Injury Was Unwitnessed

You must notify coworkers and supervisors about the injuries. Be consistent in your explanation of what happened when you injured yourself. Look out for all the terms and conditions related to workers’ compensation

You Failed to Report Your Injury Immediately

Workers’ compensation insurers also frown upon accidents that aren’t reported immediately. They’d presume you weren’t seriously wounded if you didn’t report the incident immediately.

When you get injured during your job, you should notify your state’s workers’ compensation office as soon as possible. That deadline is short and too long to wait. A job injury threatens your ability to keep working, and a report must be filled out. If you take these steps, you’ll have a better chance of receiving aid. Within ten days of the first day of disability or the day they became aware of disability, whichever comes first, the employer must complete.the First Report of Injury (FROI) form and send it to its workers’ compensation insurance carrier.

You Submitted a Claim After Being Terminated or Laid off

Sometimes, workers who have been appropriately injured on the job wait too long to file a claim for workers’ comp. They delay submitting a claim until after they’ve been fired or laid off.

If an employee files a compensation claim after being fired or laid off, the insurer will likely reject it. In most cases, they will treat the accusation as if it were a simple act of retaliation. If you’ve been hurt on the job, you shouldn’t wait to make a claim; this is another reason. If you are laid off before filing a workers’ compensation claim, you will have difficulty convincing the insurance company and the judge that your injury occurred on the job. 

The Employer Disagrees with Your Versions of Events

The company may dispute your version of events regarding the accident. They may try to pin your injuries on a preexisting condition or find flaws in your tale. They may also argue that the accident was not work-related.

You should only share information about your injury with those directly involved in the claims procedure. If you share your story with many coworkers, they may begin to compare and contrast accounts. They can misinterpret you or forget the specifics when you tell them about the accident. Doing so can lead to unjustified claims that you are lying. A hired lawyer can act as your representative and handle all communication with your employer and insurance provider.

Appealing the Decision

According to the new norms, the payment shall be equivalent to the employee’s salary for a period of three months. If a dependent receives more money than they are entitled to, the commissioner must reduce the surplus and give it back to the employer.

You have the right to appeal a claim denial made by your insurer. You can file a complaint with a third party who will decide on your behalf. Unfortunately, you only have a limited time frame from the denial date to submit this appeal. You will be awarded interest on the verdict if you are successful. Sometimes you have to go to an actual courtroom to get justice.

Firms like Cerity ensure that all your compensation premiums are in line and provide you with monthly details. It also ensures many insurance providers cover the most uncommon and unlikely injuries. Estimates from insurance industry associations put the percentage of initial claims denied for workers’ compensation at 25%. But with Cerity, for example, you can be assured that your insurance claims are provided to you in time and at a quick pace. 

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