5 Reasons Workers’ Compensation Gets Denied After Work Accidents

Workers’ comp is often seen as guaranteed benefits for injured workers. Although the law does allow injured workers to collect benefits, these benefits are not guaranteed or automatic. In fact, workers’ comp denials are quite common.

What are the main reasons for workers’ compensation denials after work accidents?

Understanding Workers’ Comp Denials

Workers’ compensation denials can be devastating for injured workers. Expecting and needing benefits, they find themselves with zero — at least initially. However, a denial in these cases is often just the beginning, not the end of the story.

Workers who have their claims denied are entitled to appeal. Depending on the reason for the denial, they may have a good shot at overturning the denial and obtaining approval. However, some reasons for denial are more difficult to dispute than others.

Pre-Existing Conditions

If you have a pre-existing condition and are injured on the job, your employer and its insurance company will make sure you do not receive benefits for that pre-existing condition.

Workers’ comp does not cover injuries or conditions suffered prior to the accident in question. The Wyoming Department of Workforce Service will deny your application if it determines that the benefits will go toward a pre-existing issue.

However, workers’ comp will cover the aggravation or exacerbation of a pre-existing condition. If your work leads to the worsening of a pre-existing condition, you can claim worker’s comp benefits based on this.

Discrepancies in Accident Reports

Case reviewers need clear narratives of work accidents and injuries. When a reviewer comes across discrepancies or conflicting facts in an accident report, they no longer have a reliable basis to make a decision and may deny the claim.

Some errors that appear in accident reports go unnoticed but can still influence the reviewer’s decision and lead to a denial of benefits. For example, if the accident report states that the injured worker clocked off before the accident when they did not, the worker will receive a denial based on that error.

Missed Deadlines for Filing Claims

Workers’ comp claims can grow stale after a short period of time, meaning they become void. In Wyoming, there is a one-year statute of limitations for workers’ comp claims. If you file your claim after the deadline has passed, your claim will be denied.

Keep in mind that work-related conditions that develop over time have slightly different time rules. If you have a work-related health condition, you have one year from the date of its official medical diagnosis to file a claim.

Insufficient Documentation

Documentation forms the backbone of your claim. Any missing pieces will likely lead to a denial. Inaccurate or incomplete applications will also be met with a rejection. This is why having an experienced workers’ compensation lawyer is essential. An attorney will ensure that your documentation is accurate, complete, and delivered on time.

Employer Disputes Over the Claim

Employers can dispute workers’ compensation claims and often do, even when the claims are valid. An objection from an employer with hard evidence can lead to a denial of some or all of your benefits. Reasons for disputing your claim include:

• You were impaired at the time of the accident
• You were horsing around when injured
• You weren’t on the clock when the accident occurred
• You weren’t engaged in work duties when injured
• Your injuries are not as serious as you claim
• You have a pre-existing condition
• You exacerbated your injury

Fortunately, you can contest some of these reasons in an appeal if your claim is denied. However, others are unappealable if true. For example, if you were truly off the clock or drunk at the time of the accident, you can’t receive workers’ comp benefits.

How an Attorney Can Help

A Wyoming workers’ compensation lawyer will fight to get you as much in workers’ compensation benefits as allowed under the law. As an injured worker, you may be entitled to pursue workers’ comp benefits. However, denials are real and common.

Insurance companies and employers want to pay as little as possible after work accidents. Their profits depend on it. Sadly, this built-in incentive works against injured workers and leads to denial or significantly reduced benefits. But a Wyoming workers’ compensation attorney knows how to compel proper payment of benefits.

With an attorney representing you, you get the advantage of:

• Properly completed benefits documents
• Compliance with legal procedures and deadlines
• A full accounting of all benefits owed to you
• A negotiator to take on insurance companies
• An advocate during appeals

You will also benefit from specific, tailored guidance that addresses your issues directly. Injured workers need personalized counsel when seeking benefits from their employers, who sometimes may be hostile.

FAQ

Is There a Deadline for Reporting My Injury to My Employer?

Yes, there is a deadline for reporting your injury. After a work accident, you should report the incident to your employer immediately and no later than 72 hours after its occurrence. Waiting too long to report can also lead to a denial of your application.

Does Reporting My Injury to My Employer Count as Filing a Claim for Workers’ Comp?

No. Reporting your injury to your employer does not qualify as filing for benefits. You must file a separate application for benefits.

What Are Some Examples of Employer Retaliation?

Employers may fire or demote a worker for filing for benefits. They may also dock pay, cut hours, and even create a hostile workplace.

Get Help With Your Workers’ Comp Denial

Has your workers’ comp application been denied? If so, your story is not over yet. Denials are just the beginning for many workers. The Spence Law Firm is ready to fight to reverse your denial and get you the money you need promptly. Call for a free consultation and learn how our team can help you.