Common Reasons Why Workers’ Compensation Claim gets Denied
Workers’ compensation insurance (workers’ comp) is a program supervised and administrated by the state’s Division of Workers’ Compensation (DWC) on behalf of businesses that maintain this insurance. This coverage is for specific work-related injuries and deaths of employees. The DWC monitors the workers’ compensation claims and assists in resolving disputes.
Here are the five most common reasons for denial of a workers’ compensation claim:
1. Employer Does Not Have Workers’ Compensation Insurance
Nearly all employers must carry workers’ compensation insurance if they have at least one employee (including a part-time employee). There is no requirement for workers’ compensation coverage for business owners, independent contractors, casual workers, or domestic help.
Executives and directors must be covered unless they entirely own the company. Sole proprietorships can opt-out of the coverage or choose to carry it. Some large companies with sufficient assets necessary to qualify, and approval by the state, can choose to self-insure.
Each state’s rules are slightly different. For example, California and Arizona require agricultural workers to be covered; Nevada and Utah do not. Also, in Utah, real estate brokers do not need coverage.
A business required by law to have workers’ compensation insurance, which does not maintain coverage, may face prosecution for violating state law, may have to pay large fines, and is liable for the damages caused by job-related injuries or deaths.
2. Deadline Missed
There are certain procedures for the claims’ paperwork and a specific timeline for filing a claim. Not making a proper claim or filing late is a common reason for denial. Therefore, it is best to file a claim as soon as possible. There are some allowed exceptions for missing a deadline. Get worker’s comp claim assistance from one of our highly-qualified attorneys.
3. Application Information Does Not Match the Incident Report
This mistake may is easy to make by anyone who is not familiar with the process. The details in the incident report filed with the employer and the employee’s claim application must match exactly. Any discrepancies, conflicting information, or disagreements between what the accident report says and what the claims application contains may cause a denial.
4. Injury, Disease, or Death Not Covered
Workers’ compensation insurance does not cover mental illnesses, some stress-related injuries, or something caused by a pre-existing medical condition. For example, there is no coverage for heart disease that causes a heart attack while at work. If a job-related accident aggravates a pre-existing medical condition an exception to this general rule may be allowed.
Having the help of a competent workers’ comp attorney is critical for a denied claim due to these reasons.
5. Insufficient Evidence that the Injury, Disease, or Death is Work-Related
Workers’ compensation insurance only covers injuries or deaths that are job-related. The cause must be something that occurred while the person is employed. Also, At the place where they generally perform job duties, and while fulfilling these duties or doing something related to their job duties.
Furthermore, disputes may arise about job-related injuries, diseases, or deaths, so get a workers’ compensation attorney to help you prepare the evidence needed to support your claim if denial happens for these reasons.
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