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What if my workers’ compensation claim is denied?” Workers’ compensation laws exist to protect employees who have been hurt on the job. But workers’ compensation insurance companies all too often would rather protect themselves.

Unfortunately, many claims for workers’ comp benefits are denied, and the worker is put at a considerable disadvantage before the claim is even processed. Reaching out to a workers’ compensation attorney before making a claim is highly recommended. Not only will the likelihood of claim denial decrease, but if your claim is denied, an experienced attorney will help alleviate the process and fight for your case.

Common Reasons Why Workers’ Compensation Claims are Denied

An insurance company may deny a workers’ compensation claim for any number of reasons. They will try to poke holes in your case any way they can. To ensure that your claim is strong, you will need an experienced workers’ compensation attorney on your side.

The injury is not reported immediately

The most common reasons that workers’ compensation claim get denied is often due to the simplest mistakes: the injury was not reported immediately.

When injured on the job, the first thing you should do is seek immediate medical attention. You should then notify your employer of the accident as soon as possible. Employers and insurance companies are far more likely to deny a claim that has been postponed or delayed. It is best to submit this notice in writing, although verbal notification is also acceptable. A written notice can serve as proof that you acted in a timely manner if an insurance company tries to argue against your claim.

Even more important than timeliness is accuracy. When informing your employer (and your doctor) of a workplace injury, provide as much detail as possible. This includes:

  • Time and place of the injury
  • Extent of the injury
  • What you were doing when the accident occurred
  • How and why the injury happened
  • The names of any witnesses

Sometimes your employer will have you fill out an accident report. Once again, make sure to be accurate. Any inconsistencies can hurt your claim.

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The injury is a pre-existing condition

Many denied workers’ compensation claims occur because the injury or illness is deemed by the insurance companies to be a pre-existing condition, meaning that the injury originated before the accident. You cannot claim compensation for a pre-existing condition. However, some pre-existing conditions are further aggravated by duties on the job. If this is the case, you may be eligible to receive compensation for your injury.

Jobs that require repetitive movement can cause significant wear and tear on the body which builds up over time. Conditions such as arthritis and carpal tunnel syndrome cannot usually be linked to one specific incident, which means you can still receive compensation for your injury as long as you can prove it was work-related.The injury is not work-related

Another common reason for denied workers’ compensation claims is because the injury is deemed to not be work-related. Therefore, it is important to know what exactly constitutes the “workplace.”

For example, injuring yourself on the way to work would not be considered an injury sustained on the job. However, if you were to injure yourself while performing an outside task specified by the job (not necessarily on the job site), this could be the grounds for a successful workers’ compensation claim. It is best to consult an experienced Massachusetts workers’ compensation attorney before moving forward.

Don’t Wait. Insurers only have 14 days to pay or deny your claim. Learn how to improve your chances of having your claim approved.