5 Top Reasons Workman’s Comp Claims Are Denied

5 Top Reasons Workman’s Comp Claims Are Denied

The Workers’ Compensation system is complex, and your claim could be turned down for any number of reasons — but what you may not know is that if your claim is denied, you have the right to appeal this decision.

In recent years, the workers’ compensation industry has been a hotbed of controversy, with many claiming they are unfairly denied their rightful benefits.

Why do insurers deny rightful claims?

Join our discussion as we explore 5 top reasons workman’s comp claims are denied.

Reason #1. Not Following Safety Regulations

What’s the first thing you do when starting a job at a new location? Well, it should be to read all safety regulations in regards to where you are working.

For example, construction sites have many hazards — from high voltage lines to heavy materials that can fall off scaffolding or shelves. There is no doubt that workers need protection while on-site, so they’re not denied their rightful claim for being injured or even killed due to an unsafe environment.

Suppose anyone did not follow these mandatory safety precautions. In that case, your company could deny workers’ compensation benefits even if they were injured on site doing what they were hired for. This means employees could technically lose out on medical coverage as well as their ability to collect.

No one should be denied workman’s compensation benefits they are entitled to because of an unsafe environment, so it is crucial that employees follow all safety regulations and keep their workplaces safe.

In order for you to get the workers’ comp that you deserve while on-site at a construction site or other hazardous location, make sure your employer has these mandatory safety precautions in place:  

  • A written accident prevention policy
  • Provide training about health hazards
  • Use appropriate personal protective equipment (PPE) and provide first aid kits near areas with a risk of injury from chemicals or fire.

Make sure you follow all rules and regulations while on-site at a construction site or other hazardous location if you want to have the best chance of receiving compensation.

Reason #2. Lack of Worker Training

Another reason why workman’s comp claims are denied is that the employee did not receive appropriate training. Your employer must provide the necessary safety precautions and train its workers about health hazards per state law.

If you were not adequately trained, your employer may be liable for the accident and injuries sustained.  

It is essential that safety precautions like these are taken seriously to protect both employees and employers from any significant losses due to an injury caused by unsafe working conditions.

It is also the company’s responsibility to  provide first aid kits near areas with a risk of chemical exposure or fire — after all, accidents happen at every type of workplace in some form or another, no matter how often we take steps to prevent them.

It’s important to ensure that you have the appropriate training in these areas before being allowed on site. Also, employers must ensure that there are adequate guard rails or barriers installed and any other necessary precautions like warning signs.

Reason #3. Failure to Report an Injury or Illness

You must report any injury or illness sustained on-site. This includes, but isn’t limited to:    

  • Occupational illnesses
  • Non-occupational injuries and illnesses
  • All work-related deaths (regardless of whether they were caused by accident)
  • Any other incident in which a worker’s health was jeopardized because of exposure at work.

Failure to do so could result in fines for both the company and individual employees who fail to comply with these regulations.

It’s also important to note that the company is required to provide written notice of injury or illness, including any work-related death, within 24 hours. The Occupational Safety and Health Administration (OSHA) will inspect this report as well as investigate accidents or injuries to prevent future incidents.

These reports factor heavily into a decision to approve or deny a workman’s comp claim.

Reason #4. Falsifying Records, Such As Time Cards and Work Logs 

Workers’ compensation fraud is rampant — especially in the construction industry. This type of insurance fraud occurs when workers or their employers purposely deceive an insurer for financial gain.

Some examples include:

  • Faking injuries to collect benefits that you are not entitled to, such as collecting payments for a work-related injury or illness while still working at your regular job
  • Using false documents (such as fake doctor’s notes) to prove you were injured on the job so you can receive money from your employer’s workers’ comp policy.

Not only does this sort of fraudulent activity cost insurers billions in payouts each year, but it also hurts honest contractors.

Reason #5. Working While Intoxicated or Impaired by Drugs/Alcohol

Workers impaired by alcohol or drugs on the job will often attempt to get workers’ compensation benefits. Unfortunately, this means that many of these claims are denied.

If your employer has a policy about drinking at work and you violate it and end up with an injury, then there is little chance you’ll be entitled to any type of claim.

If you have been employed in an industry with high rates of substance abuse like construction sites, you might find yourself familiar with this issue more than in other sectors.

Also, it’s important to note that if you’re injured under the influence of a prescription drug, the insurer may deem your claim invalid.

Many carriers are also willing to hire third-party legal counsel who can help with these types of claims. If your company doesn’t offer this assistance or provides poor service (such as not giving timely answers), then it’s time to get professional legal counsel to ensure you don’t lose out on things like medical care promised under the policy.  

Get the Help You Need to Appeal Your Workman’s Comp Claim

Filing a workman’s compensation claim may be daunting, but Minnesota provides a broad set of protections for workers. Always report and document your workplace injuries, then seek legal representation to help you navigate the claims process. The more details you have, the better. And remember, the sooner you start the process, the sooner you can recover and get back to a normal life.

For expertise in workman’s compensation law and to connect with compassionate legal counsel in Minnesota, reach out to Sundquist Law Firm if you have been injured on the job. We’re happy to help you fill out forms, prepare your evidence, and make your claim. Don’t delay: if you’ve had a workplace injury, see your doctor, alert your employer, then give us a call.