Common Reasons for Workers’ Comp Denials

Common Reasons for Workers’ Comp Denials

Under Alabama law, most employers are required to carry workers’ compensation insurance that provides employees with benefits if they are injured in an on-the-job accident. In addition, this insurance will provide benefits if a worker develops an illness or medical condition as a result of their working conditions.

Unfortunately, many workers’ compensation claims are denied. Some of the most common reasons are explored below, and if you have recently had a claim denied, you should contact a Montgomery workers’ compensation attorney as soon as you can.

Failing to Notify Your Employer

Alabama workers’ compensation laws require an employee to notify their employer of an injury or medical condition within five days. This is a very short timeframe, especially when you are dealing with the aftermath of an injury and undergoing medical treatment. However, if you do not notify your employer by this deadline, the workers’ compensation insurance company can deny your claim. 

Your Injury Was Not Work-Related

The primary requirement to be eligible for workers’ compensation benefits is that your injury or illness happened or stemmed from the course of your employment. Insurance companies often try to characterize an injury as not work-related in an attempt to avoid paying benefits. For example:

• If you claim you injured your back at work, the insurer might allege that your injury happened while doing household chores.
• You suffered injuries in a car accident while driving to another worksite, but the insurance company claims you made a personal stop, so it was not part of your employment.

You want help from a lawyer to prove that your injury was work-related and that you deserve workers’ comp benefits. 

Pre-Existing Conditions

If you have pre-existing medical conditions, the insurance company might try to deny your claim. For example, if you had back problems and previously received treatment, then you re-injure your back at work, the insurer might claim this is all the same previous injury. You must provide proof that your work-related injury is distinct and separate from your pre-existing injury. You can also show that the workplace incident worsened a prior injury, leading to the need for medical treatment that you otherwise would not have needed. 

Employee Misconduct

If an injury stemmed from the injured employee’s own misconduct, the insurance company will likely deny the claim. For example, if an employee is under the influence of alcohol and drugs, and their intoxication leads to an accident and injuries, the insurance company will deny workers’ compensation benefits. Sometimes, employers might claim an employee’s misconduct was to blame - when in reality, there was another cause of the accident. 

Speak with a Montgomery Workers’ Compensation Attorney

The Law Office of Richard F. Matthews, Jr. Attorney at Law handles workers’ compensation claims and appeals for injured workers in Montgomery and the surrounding areas. If you need help filing a claim, we are ready to assist. If you learn that your workers’ comp claim was denied, never delay in seeking legal help from our firm. Contact us today for more information.