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Tyler & Associates, PC
Bettendorf, Iowa And Quad Cities Trial Attorney

The 5 most common reasons why workers’ compensation is denied

Whether you work in the construction, loading dock, production, warehouse, trucking, or any other blue-collar industry, you face daily hazards to perform your job duties adequately.

Hazards you face may include mechanical malfunctions, unstable or slippery platforms, operating dangerous machinery, or environmental hazards, among others. These on-the-job threats rear their ugly in the form of slips and falls, cuts, abrasions, broken bones, concussions and more severe injuries like compound fractures and permanent disability.

If you suffer an injury at work, you expect to receive workers’ compensation to cover your necessities and bills while you’re on the mend, but sometimes these claims get denied. A big mistake some workers make is choosing not to hire a workers’ compensation attorney to represent the best interests. An attorney will do their best to ensure your claim is accepted, and if it isn’t, will fight toward having your claim is converted and paid.

The following reasons most commonly lead to initially denied workers’ comp claims.

  1. Not reporting your injury to your employer on time: In Iowa, the law states that you have 90 days to report an injury, but reporting the injury earlier would better your chances of getting your claim approved.
  2. Seeing your personal doctor: If your physician is not in your employer’s insurance network, it would be wise to avoid that doctor for this injury. You may feel most comfortable seeing a doctor you’re used to, but if you want your medical bills covered by workers’ comp, seek out a doctor associated with your employer’s network.
  3. Filing a claim for an injury that’s unrelated to your job: While this seems unfair, I mean the injury did happen at work, but a rabid animal coming into the warehouse and biting you will likely not get your covered.
  4. Poor communication: Rehearse, rehearse, and then rehearse some more. Make sure the story of your injury is truthful and detailed. At the time of the injury, take pictures or video and identify witnesses that could speak on your behalf. Denied claims can boil down to a lack of communication, like the injured worker not providing a clear story to their doctor. Make sure you tell the whole story and its repercussions (aches, pains, strains) in all parts of your body since the accident, not just the initially injured body part.
  5. Pre-existing conditions: In nearly all areas of insurance coverage, insurers frown upon treating a condition that existed before the injury, even if the injury leads to your pre-existing condition to worsen or reemerge.

A silver lining

A study by Lockton, an independent insurance brokerage firm, discovered that nearly 70% of denied workers’ comp claims are converted and paid. Those reversed claims, paid out, on average, 50% more than the original claim amount. This doesn’t mean that you should purposefully mess up your claim in hopes that you’ll receive a bigger payout. The reality is quite the opposite, but the study does provide a possible silver lining for worker’s claims that are not initially accepted.