Common Reasons Workers’ Compensation Claims are Denied

If you were injured on the job or developed a medical condition because of your work, workers’ compensation benefits should be available to compensate you. In Alabama, most employers with five or more workers are required to carry workers’ comp insurance for their employees.  But although you may be eligible for benefits through workers’ comp, the claims process is very confusing, and employers and their insurers will look for any reason they can to deny the claim. 

If you have been denied workers’ comp benefits, this is not necessarily the final word. There are some legitimate reasons why the claim may be denied, but in many cases, employers throw up unnecessary barriers to frustrate an injured employee into giving up and not pursuing the benefits he/she deserves. If this has happened to you, the best place to start is to speak with an experienced Alabama personal injury lawyer to review your case and discuss your legal rights and options.

Why Would My Workers’ Compensation Claim Be Denied?

There are several reasons why workers’ comp claims are frequently denied, here are some of the most common:

• The Injury was Not Reported in a Timely Manner: In Alabama, you are generally supposed to report a workplace accident or occupational illness within five days (although there are some exceptions to this rule). Failure to report your injury right away can spell trouble for your claim, because if you do not tell your supervisor about your injury in a timely manner, it makes it far more difficult for them to carry out an accident investigation, which will be needed to process your claim. Another problem with reporting the injury later is it could give cause to claim that the injury did not really happen at work, or that it did not happen because of your job duties.

• Your Employer says the Injury was not Work-Related: There are often disputes over whether the injury or illness is related to the job. Not reporting right away is one possible reason an employer might make this assertion. Or, an employer may say that the injury happened while you were not at work or “off the clock”. For example, you were clocked out for lunch and got injured on your way to pick up some food. If you were just going out to get food for yourself, you may not have a valid claim. However, if you were going to pick up food for your supervisor and other coworkers, and there might be an argument that the injury is work-related.

• There is no Supporting Medical Documentation: If you believe your injury is serious enough to file a workers’ compensation claim, you need to seek medical treatment for it as soon as possible. Along these same lines, it is very helpful if you have witnesses and if you can describe in some detail what happened to you – as opposed to just saying “I fell down”. Without some evidence and supporting medical documentation, the insurance company may claim that you faked the injury, or that it is the result of a preexisting condition.

• You Were in Violation of a Company Policy when the Injury Occurred: Workers’ compensation is a “no-fault system”, meaning an employer is supposed to provide benefits regardless of who was at fault for the injury. However, there are some exceptions to this rule.  For example, your claim can be denied if you had alcohol or illegal drugs in your system at the time of the accident, got injured because of “horseplay”, refused to wear required safety equipment, or violated some other company policy.

• Your Statements Contradict your Claim: Be very careful how you describe the accident or circumstances that led to your injury or illness. Be honest about what happened from the outset and be sure to correct any misstatements you may make right away. Also be very careful how you discuss your workplace injury on social media. Generally, it is best to stay off of social media while your claim is being processed. But if this idea is not practical for you, at the very least, refrain from posting any status updates or making any comments related to your injury.

What Can I Do if I was Denied Workers’ Compensation Benefits?

If your Alabama workers comp’ benefits were denied, your next legal step is to file a lawsuit in state court. This is a very complicated process, and you will need strong legal counsel by your side to help you navigate the complexities (of this process) and work toward a favorable outcome.

At Mann & Potter, we have extensive experience successfully representing Alabama workers who have been denied workers’ compensation benefits, and we can thoroughly evaluate your case to determine if you have a valid claim. To schedule a free consultation with one of our attorneys, call us today at 205-879-9661. You may also message us online with more details about your case or stop by our Birmingham office in person at your convenience.