Claim Denied

WHY WAS MY WORKERS’ COMP CLAIM DENIED?

You suffered an injury on the job.  Maybe you strained your back while lifting something heavy.  Maybe you felt a pop in your knee when climbing down a ladder.  Perhaps you have developed wrist pain and weakness after years at the computer.  However the injury occurred, it happened at work and you feel you have a valid Workers’ Comp claim.

But one way or another, you find out your claim has been denied.  Why would this happen?  Let’s discuss some of the reasons why a Workers’ Compensation claim may be denied.

Notice to your employer

As soon as you are aware that you have an injury that happened on the job or as a result of your work activity, you need to immediately notify your employer – your supervisor or Human Resources representative.  They should have an  accident report or form to complete to take down information regarding your injury. You have thirty (30) days from the date of injury to provide proper notice to your employer.

Notice to the Workers’ Compensation Board

In addition to notifying your employer, a claim needs to be filed with the Workers’ Compensation Board.  This is not your employer’s responsibility.  A C-3, Employee Claim Form, (which can be found on the Workers’ Compensation Board website) needs to be filled out and submitted within two (2) years of your work related injury.

Medical Evidence

A Workers’ Compensation claim has strict requirements when it comes to medical evidence to prove your case.  Your medical provider must provide a report which specifically identifies 1) a history of your work activity, 2) a diagnosis of the injury, and 3) a statement that the injury is causally related to your work activity.  This is the basis of your claim and all Workers’ Compensation cases rely heavily on medical evidence.  Without these key pieces of information, a Workers’ Compensation Law Judge does not have a basis to establish a Workers’ Compensation claim.

Pre-Existing Condition

Having a pre-existing condition is a hurdle that can ultimately be overcome in a Workers’ Compensation claim; however, it is also a reason why an insurance company will initially deny a claim.   For example, perhaps you have had back pain and problems for many years for which you have seen your primary care doctor occasionally.  You experience a back injury while at work which causes you to lose time – maybe even require surgery.  An insurance company may try to allege that you had a preexisting back injury and use that as reason to deny your Workers’ Compensation claim.

Occupational Disease

We’ve talked about occupationally developed conditions in a prior blog “Work-Related Condition That is Not a Result of an Accident”.  Some work injuries develop over time and are not the result of a particularly identifiable incident.  These types of claims are often the most difficult for insurance companies to recognize and many times they are denied for that reason alone. 

So what do you do when your Workers’ Compensation claim is denied?  It is certainly no reason to give up!  A denied Workers’ Comp claim will likely require litigation and hearings at the Workers’ Compensation Board.  The insurance company will have an attorney representing them.  You should have an attorney to protect and fight for your rights. Contact Zea Proukou to further discuss the steps necessary to properly defend your claim.