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Why Do Some Workers’ Comp Claims Get Denied?

September 6, 2021

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Because almost all employers in Ohio are required to purchase workers’ compensation insurance, many workers assume that their claims will go smoothly after they get hurt on the job and are unable to work. But that’s not always the case. Many claims get denied, even though workers’ compensation is a no-fault system where injured employees can get benefits even if they’re at fault!

What gives? Ultimately, employers and their workers’ compensation insurance providers may fight back against certain claims. And when it happens to injured workers, it can be devastating. Workers’ compensation benefits are lifelines for injured workers, and without them, they can struggle to keep their heads above water financially.

Here are a few reasons why workers’ compensation claims get denied—and how we help injured workers and their families after being told “no” by their employers and workers’ compensation insurers.

The employer disputes the claim.

When a supervisor, manager, or business owner says that an injury didn’t happen as the injured worker describes it—or even claims that it didn’t happen at work period—it can throw a wrench in a workers’ compensation claim. In cases like this, applicants need plenty of evidence on their side so that their employers and their employers’ insurers can’t simply deny reality and get away with it.

The injured worker waits too long to tell someone about their injury.

Workplace injuries should be reported immediately. Even waiting too long to report them on the same day they occurred can be detrimental to a claim’s chance of success, let alone waiting days or weeks. When injured workers wait too long to report their injuries, their supervisors may become suspicious, and their employers’ workers’ compensation insurers may assume that their injuries happened at home or off the job site.

The injury was pre-existing and aggravated at work.

Pursuing compensation for an injury you suffered outside of work, whether it was yesterday or 10 years ago, won’t fly. But you CAN get compensation for aggravating or worsening a pre-existing injury while you’re on the job. However, you may get less money overall for this type of claim, and you’re also more likely to have your claim denied, as your employer or their insurer may argue that your job had nothing to do with your injury.

The injury wasn’t witnessed by anyone or recorded on camera.

Many perfectly valid workers’ compensation claims are held up or denied because there were no witnesses to the accidents and injuries. Although it’s still possible to get benefits for an injury that no one witnessed and that wasn’t captured on camera—especially if you seek immediate medical attention—a lack of proof that it happened at work can result in a denial.

The injury wasn’t treated by a doctor.

Even if there’s evidence that the injury occurred and it was promptly and properly reported to a supervisor, an injured worker may have his claim denied if he wasn’t treated by a doctor. Successful workers’ compensation claims require actual diagnoses from healthcare providers. Waiting too long to get treatment can also jeopardize claims.

The statute of limitations expired.

Ohio’s statute of limitations on workers’ compensation claims is one year from the date of the injury. If injured workers don’t apply for benefits before that day, they’re forever barred from getting any compensation, regardless of the severity of their injuries or how long they’ll be disabled by them.

The injury occurred because of intoxication or impairment.

Although workers’ compensation benefits are considered no-fault, workers can have their claims denied if their injuries occurred because they were intoxicated or impaired. Most workplaces have zero-tolerance policies against alcohol and drugs, and workers’ compensation benefits are only granted to workers who were injured while free from the influence of any non-prescription substance.

The claim was pursued without the help of a lawyer.

There’s a lot to keep track of in even the most slam-dunk workers’ compensation claim. Minor errors like missing paperwork or incomplete forms can result in denied claims and weeks or months without money for injured workers. Having an experienced lawyer on their side from day one helps injured employees avoid unnecessary delays and denials.

Avoid the Pitfalls—Get Our Experienced Ohio Workers’ Compensation Lawyers on Your Side.

These are just a few of the reasons that workers’ compensation claims get denied. There is an almost countless number of excuses and rationalizations employers and their insurers can come up with for denying claims, and the result is that countless injured workers face uncertainty and financial hardship while recovering from serious injuries.

At Nurenberg, Paris, Heller & McCarthy, our goal isn’t just to get our clients the benefits they’re owed—it’s to give them peace of mind. We have decades of experience helping injured workers get approval, whether they’re filing for benefits for the first time or appealing a denial. Contact us today for a free consultation and to find out how we can help you.

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