How Your Workers Compensation Benefits May Be Denied

If an employee is hurt while on the job, an employer may be responsible for paying workers' compensation benefits. Those benefits may include reimbursement for medical bills, payment for authorized doctor's visits, physical therapy, prescription drugs, mileage reimbursement for traveling to and from authorized doctors and pharmacies, and lost wages.

But workers' compensation claims can be difficult and complex processes. For example, what if you were in a serious car accident while traveling to and from work, but your company-furnished office was located in your home? Would that still count as a workers’ compensation claim?

If you understand the ways in which workers' compensation claims could go wrong, it may help you become better prepared to work alongside a workers’ comp attorney in getting your claim approved.


Reasons for Denial

You didn’t report your claim in time

One reason why an employer and insurance company may deny a workers' compensation claim is that it was not reported within the state's prescribed time period. It varies from state to state, but an employee should report his or her claim as quickly as possible. Sometimes the state's allotted time for reporting the claim may be the only factor holding back the employee from their workers' compensation benefits. In Florida, your claim must be reported within 30 days and you must get treatment within two years. So it's important to report an injury as quickly as possible.

You don’t have proof or documentation

Not receiving any medical treatment for the injury may be another reason why an employee is denied their benefits. An injured employee should request of their employer treatment from an authorized doctor or specialist so that they have documentation to prove the injury. But not only that, the employee should seek the most documentation of their injury possible. They should ask their doctor or specialist for detailed reports, rather than general ones, and copies of any X-rays and MRI's that are taken. Also, the employee may want to consider keeping a journal of their injuries, their doctor visits and specifically the dates and details of what occurs.

You may not have technically been working for your employer

Also, there may be disputes on whether or not the employee was actually working when the injury occurred. As described above, what if you are traveling to your office, but your office was at your home, and it was for a work-related purpose. Where does the job begin and where does it end? It's important to understand the specifics of your claim and be prepared for the worst.

Having a pre-existing medical condition may also compromise your claim for workers' compensation benefits, because the employer and insurance company may not be convinced that the main reason for the treatment of the injury was the result of a workplace accident. That is why it's crucial for an employee to seek medical treatment right away, make a claim for workers' compensation benefits just as quickly, and document their health as best and accurately as possible.


There is a potential for fraud

With all of these issues that could arise from a workers' compensation claim, an employee should be aware that the process may not always be as simple as they think. Employers and insurance companies may also deny a claim for benefits, alleging that the employee is committing fraud in order to receive workers' compensation benefits. For example, an employee with a previous injury might claim they hurt their back while working when they happened to have a herniated disc in the past. If the insurance company asks the employee if they've had back injuries in the past and the employee says no, they may raise fraud defense to claim that the employee's injury was a result of past medical conditions and not from an accident at the workplace.

There is also some controversy over drug testing in a workers' compensation claim. If your employer is making you take a drug test during an open claim, it can seriously affect your case.


The Workers’ Compensation Attorney and Your Benefits

All in all, some claims may be simple, and going to the doctor and receiving documentation of the injury may be all an employee needs. But other times a workers' compensation claim may be more complex and may therefore require more documentation, time, money and critical thinking. An experienced workers' compensation attorney may be the extra edge an injured employee needs to prevent a claim from being denied or to fight against a denied claim. If you find yourself in a complex claim for workers' compensation benefits, consider seeking the legal counsel of a workers’ compensation attorney today and call the Coye Law Firm at 800-648-4941.

It could be the difference between benefits had and benefits lost.



Call 407.648.4940 or contact Coye Law Firm today for a free consultation about your case.

The expert injury attorneys at Coye Law Firm are experienced with Florida, New York, Michigan, and District of Columbia law and are here to help the injured.

Discover POWERFUL SECRETS and COMMON LIES of Florida Workers' Compensation 

If you are someone you know is struggling with the workers' comp process, get a FREE hard copy of my workers' compensation book and you will be squared away in no time!

From my book you will learn...

  • The one thing you MUST do within 30 days of a work injury (page 16)
  • How to fill out a First Report of Injury form (page 20)
  • The first step you need to take to receive wage loss benefits (page 54)
  • What medical decisions your employer can make for you (page 26)
  • How to protect your benefits after being placed on light duty (page 38)
  • How to deal with rude workers' compensation doctors (page 39)
  • Disastrous workers' comp traps to avoid (page 83)
  • Others methods to pay for your medical costs (page 45)
  • What "maximum medical improvement" means for a claimant (page 63)
  • ...and much more.

To receive your FREE copy, click here