Saturday 22 June 2024

Reasons Why Employer Deny Worker’s Comp Claim

When an employee gets injured or ill at workplace or due to work-related issues, they make claim for workers’ comp benefits. Employers pay premiums against workers’ compensation benefits, which is mandatory in majority of states.

Main reasons for employer’s dispute

  • Employers dispute workers’ comp claim, because their insurance premiums increase.
  • If more claims get filed means the employer’s premium costs get escalated.
  • If the claim is especially expensive like back injury surgery, then both the employers and insurance provider’s dispute.

Thus you can see the main aim of the employer and insurance provider is whether to SAVE money or the employee. Investigative companies are hired to monitor the routine activities of the employee, who has filed workers’ comp claim. In this way, they try to gather evidence to contest the claim.

Employer are biased

Many employers don’t think that some injuries can be valid or serious, especially communal trauma injuries. They presume that an employee who claims workers’ comp benefits owing to repetitive stress injury, carpal tunnel syndrome, or lumbar back damage is not honest or is feigning sickness for financial gains.

Employer are biased strongly, especially against injuries that involve inexplicable pain, which cannot be medically verified by examination or X-rays or nerve conduction studies or imaging. This does not mean that the injured employee with consistent back pain is pretending. Several medical conditions are hard to verify without bias.

Denial is the only way that helps employers to reduce the amount they need to pay for liability and insurance.

Reasons for workers’ compensation claim denial

Claim denials either fully or partially are given by the employer of their insurance provider in writing.

Typical reasons for disputing a claim

  • You have not sustained grave injuries that need medical attention.
  • The injuries or accident is not work-related. Workers’ comp benefits is available for those injuries occurred on job or while conducting job-related duties.
  • Your injuries were pre-existing because of prior injury or natural aging, not related to work. It is worsened or aggravated by work-related injury.
  • Your injuries are not grave, so there is no need for time-off. The areas of body required to conduct the task is not affected.
  • Your claim was not filed on-time. Actually, claim needs to be filed within 30 days prior accident.
  • Lack of evidence
  • You are honest about injuries

If your claim gets denied initially, then don’t give up. If you find it hard to handle insurance adjuster and he employer, then consult workers comp attorney San Diego.

Generally, employee need not worry what the employer believes about the claim filed. It is their right to take time-off for recovering from injuries and have their medical care paid for.

Basically, employee has waived their rights to take legal action against the employer for work-related injuries in exchange for Workers’ compensation benefits. They should never feel guilty to use the financial benefits.

Therefore hire a lawyer instantly because an appeal on claim denial is the best solution. Remember appeal time limits are short and with an experienced lawyer, you will certainly prepare a solid case.