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Reasons why your workers comp claim might be denied

On Behalf of | Apr 19, 2019 | Workers' Compensation

Being injured at work and losing your ability to generate income can be devastating. Even more devastating can be when your workers’ compensation claim has been denied.

If your claim is denied, the insurance company will notify you by letter and that letter will list the reason for the denial.

Your claim can be turned down for many reasons. Some of these include:

Injury didn’t happen at work – You must be on the job or on another location performing your job for your claim to count. If you weren’t on the clock – even if you were on the job site – your claim can be denied.

You didn’t tell your employer soon enough – If you are injured at work, first you should seek medical treatment. Next, you should tell your employer about the injury. If you wait too long to tell your employer, your benefit claim could be denied.

You didn’t fill out the form correctly – If the description of the accident is inaccurate about what happened, where it happened, what you were doing or what body parts were injured in the accident, an insurance adjustor is likely to deny the claim.

You have made too many workers’ compensation claims – If you have a history of filing claims, the insurance adjustor might think you are trying to game the system.

You weren’t treated by an approved provider – Your employer and their insurance company can give you a list of approved medical providers, and you are required to see one of them.

The injury isn’t treatable – Claims for stress-related injuries are not covered in many states.

You don’t have medical records – If you want to file a workers’ compensation claim, you need to have medical records to back it up.

Your injury was the result of horseplay – Even if it happened on the job site, injuries that are the result of roughhousing are not acceptable for a workers’ comp claim.

You have a pre-existing condition – If your insurance company can show that your injury is the result of a pre-existing condition, it is unlikely to cover the claim.

If you believe the claim denial was incorrect, you can appeal the decision with the Maryland Workers’ Compensation Commission. This body can countermand an insurance adjustor’s decision and approve benefits.

Finally, if you disagree with a ruling by both the insurance adjustor and the Workers’ Compensation Commission, you can appeal the decisions to the Circuit Court of Maryland.

Workers’ compensation claims can be tricky. The advice of a qualified, experienced attorney is your best bet to make sure your workers’ compensation claim is approved.

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