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Why Was My Workers' Compensation Claim Denied?

Morales & Cerino

Employers in Florida and the country, in general, are required to carry workers’ compensation insurance if they employ more than five workers. Workers’ compensation is meant to protect both the employer and workers in the event that the latter suffers an injury while on the job. It allows the worker to recover compensation for their medical expenses, ongoing treatment, and lost wages while protecting the employer from being on the receiving end of a personal injury lawsuit.

Unfortunately, there may be times when you are legitimately injured at work, but your claim might be denied. While this is a frustrating situation and definitely unfair, there are certain reasons why the insurance company may deny your claim. It’s important to know why this occurred. There are certain situations that commonly result in a denial of your workers’ compensation claim.

Not Immediately Reporting Your Injury

Not reporting your injury immediately is perhaps the most common reason for a denial of a workers’ comp claim. You are required to report it to your supervisor as soon as possible so the insurance company can be made aware of the situation. If you procrastinate, it can work against you and prevent you from recovering compensation. In some cases, you may be required to report your injury within seven days. The sooner it’s reported, the better your case. Your supervisor can also help you fill out an accident report to help with your claim.

No One Witnessed the Injury

If your injury was not witnessed by a coworker or anyone else, it can negatively impact your workers’ comp claim. The insurance company wants proof of the incident that rendered you injured. Unfortunately, many employees suffer injuries without any onlookers seeing it. At the same time, even if there were no witnesses, you should report the incident to your supervisor immediately.

Contradiction Between the Accident Report and Medical Records

The accident report and your initial medical records should always match. Therefore, if there is a contradiction between the two, such as how the accident occurred, it can lead to a denial of your workers’ compensation claim. Always ensure that you tell everyone, from your direct supervisor, coworkers, human resources office to doctors and other healthcare professionals, exactly how the accident happened.

Initiate Medical Records Indicate Drugs in Your System

If your initial medical records following the at-work accident show you had illegal drugs in your system, your workers’ comp claim can be denied. The insurance company will view the accident as being your own fault as a result.

Your Claim was Filed After You Were Fired or Laid Off

Unfortunately, if the filing of your workers’ comp claim was delayed and you were subsequently fired or laid off, it can work against you. The insurer will not compensate you if you are no longer an employee and view your claim as revenge against your former employer for letting you go.

Refusing to Give a Recorded Statement to the Insurer or Sign Medical Authorizations

Sometimes, an insurance company will request a recorded statement from an injured worker describing the events that led up to their accident and injury. However, this is almost always a negative situation, especially if you don’t already have an attorney on your side. You are also not legally obligated to give recorded statements. It is a common tactic the insurer uses to deny a claim. You may also be asked to sign medical authorizations that allow the insurance company to contact your doctor and other healthcare providers to gain your medical records and bills. You are under no legal obligation to do this, either. If you refuse, the insurer can use that against you as well to deny your workers’ comp claim.

If you are based in the Miami Dade County or South Florida, in general, and had your workers’ compensation claim unfairly denied, you need the assistance of a skilled Hialeah injured workers' compensation lawyer. Contact Morales & Cerino (305) 340-2630 at your earliest convenience to discuss your case.



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