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Top 5 Reasons Why Workers' Comp Claims Are Denied

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If you have suffered an injury or developed illness while working in Texas, you may be eligible for workers’ compensation benefits which cover your medical expenses and lost wages until you’re healthy enough to continue working or find another job.

Unfortunately, it is not uncommon for employers and insurance companies to deny workers’ comp claims—even if they are legitimate. Workers’ compensation insurance companies are committed to protecting their own best interests and bottom-line, which means they will find any way possible to deny a claim.

The following are the five most common reasons why workers’ compensation claims are rejected:

  1. You failed to report your injury in a timely manner – You must report your injury or illness immediately to your employer to receive workers’ comp benefits. If you do not report the accident right away, your employer or the insurance company may claim that your injury wasn’t serious enough or doesn’t exist.
  2. You failed to obtain medical treatment – After suffering an injury in a workplace accident, many employees make the mistake of not seeing a doctor and waiting until the injury will go away in time. However, if symptoms from the injury persist, a delay in receiving medical care will result in the denial of your workers’ comp claim. In order to prove your injury is legitimate, you must seek immediate medical attention and obtain records from a doctor which prove your injury is valid.
  3. Your employer disputes your injury – Your employer may claim that you weren’t performing your job duties when the accident occurred, or you were involved in some form of misconduct during the time. It is imperative to collect evidence to support your claims, such as eye witness accounts or further medical evidence.
  4. You were under the influence – If you suffered a work-related injury and the drug test results show that you were intoxicated from drugs or alcohol, the insurance company will not offer you workers’ comp benefits.
  5. You filed the claim after you left the job – Insurers often do not approve workers’ compensation claims which are filed after a worker has been fired or quit—often assuming the employee is out for revenge against the company. But there are some instances where the delay was necessary. For example, perhaps you suffered an injury after giving your two-weeks’ notice. Or maybe your employer fired you out of retaliation for filing a workers’ compensation claim.

If your workers’ compensation claim was denied, do not give up. Your denial letter should include the reason why your claim was rejected. If it was due to a simple mistake in paperwork, contact the claims adjuster to see if you can resolve the issue. On the other hand, you can appeal your denial with the help of an experienced attorney.

For more information about workers’ compensation in Texas, contact our Houston workers’ comp attorneys at Daspit Law Firm today and request a free consultation.

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