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Three Reasons Workers’ Comp Claims Are Denied And What To Do Next

On Behalf of | Mar 31, 2016 | Workers' Compensation |

You have been hurt on the job and done what you were supposed to do. You obtained medical treatment and promptly reported your claim to your employer. You’ve filed your worker’s compensation claim and started to focus on your recovery only to find out your claim has been denied.

If your claim has been denied, you should know you are not alone. The following are three of the top reasons insurance companies deny workers’ comp claims what steps you can take if it has happened to you.

According to FindLaw, here are three of the top reasons insurance companies deny claims that were reported and filed on time:

1. Injured away from work — Insurance companies are eager to uncover workers’ compensation fraud and often conduct detailed investigations. One of the most common reasons an insurer will deny a claim is if they discover that the injured employee was injured somewhere else. This includes employees injured on the way to work or driving home.

2. Previous injury — One of the places insurance companies look when evaluate a claim is your medical records. If you have had a similar sort of injury from a prior event, such as a back injury from a car accident, an insurance company may deny the claim.

3. Not work-related — Insurance companies frequently deny claims for not being work related. This can happen for two reasons. If an insurance company believes the employee was roughhousing or otherwise goofing off and not performing work-related duties. The second reason is surprising. Insurance companies may try to claim that a repetitive motion injury such as carpal tunnel or hearing loss is a function of normal aging and not work-related at all.

What’s next? What you can do if your claim has been denied

Just because your claim was denied, you should not assume that you are unable to recover benefits. You can file a petition with the Nebraska Workers’ Compensation Court to challenge the decision. You have a limited time to challenge the claim.

The petition is a lawsuit. When you go to court, you will need to bring evidence that refutes the insurance company’s determination, including medical records and any other evidence to support your position. You may want to consider having the skills of a knowledgeable workers’ compensation attorney to assist you with your denied claim.


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