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Workers’ Compensation: A Denial Doesn’t Mean an End to Your Pursuit of Compensation

On Behalf of | Dec 23, 2019 | WC - Denied Claims |

While workers’ compensation is in place to help injured parties return to their pre-injury lifestyles, the process often doesn’t reflect that. This is because insurance companies have a focus on protecting their profit, meaning they typically do everything in their power to deny workers’ compensation claims from injured workers— and while a denial may put a temporary hold on pursuing compensation, it doesn’t have to be the end of the road for your workers’ compensation case.

What Is Workers’ Compensation?

To help get to the bottom as to why your case was denied, it’s important to understand what workers’ compensation is, and what it isn’t.

Workers’ compensation is a form of insurance put in place to ensure that workers who have been injured on the clock have the ability to recover compensation for economic damages. Unlike a personal injury lawsuit, workers’ compensation doesn’t require a negligent party to pursue compensation— meaning that even if you are the one responsible for your injuries, you are still eligible to recover.

However, there are certain conditions that must be met for you to continue on with a workers’ compensation case. Some of the requirements to pursue compensation include:

  • Your injury must have occurred from an activity that is part of your duties as an employee.

  • Your injury must qualify for workers’ compensation.

Common Reasons for Denial

Regardless of your job title, there will be strict deadlines and regulations in place that the insurance companies can use against you when it comes to filing a workers’ compensation case. Workers’ compensation claims are denied much more often than you would expect because again, the insurance company and your employer want to keep costs low.

Some of the most common reasons for denial include:

Failure to Inform Your Employer of Your Injury in a Timely Manner

In accordance with workers’ compensation guidelines, you must report your injury as soon as reasonably possible to your employer. Your workers’ compensation case does not begin until you notify your employer, and failing to do so may be grounds for claim denial.

Your Injury Wasn’t From Work

Your injury must be connected to your work in order to file for workers’ compensation. If your injury was sustained before or after your work hours, it may not be covered.

For example, let’s say you went to Starbucks during your break and you broke your ankle. This will likely not be covered. However, say you were at Starbucks because your boss had you pick up orders for the client meeting, which led to a broken ankle— this should be covered under workers’ compensation law.

You Were Under the Influence While You Sustained Your Injury

In Minnesota, a positive drug test alone is not grounds for workers’ compensation denial. The employer has to also establish that their employee was under the influence of illegal drugs at the time of the accident, and it must be a major cause of the injury. However, the presence of any drugs relating to your injury typically means that the insurance company will deny your case.

Your Injury Claim Was Disputed by Your Employer

Employers will often attempt to dispute their employees’ claims by stating the injury was a pre-existing condition, which is not related to work. Some may even state that your injury isn’t real and that you may be faking it. When this happens, it’s your job as the employee to prove that your injury is, in fact, real and that it occurred at work. This is where the help of a trusted Minnesota workers’ compensation attorney can help you fight for your rights.

Your Injury “Isn’t Severe”

While it may come as no surprise, there are many illegitimate workers’ compensation claims filed each year. Because of this, insurance companies have had to enforce (even more) strict guidelines. Unfortunately, these new guidelines have caused many legitimate claims to get denied.

How to Appeal a Denied Claim

It’s understandable for you to become frustrated after hearing of your claim denial. However, this doesn’t mean the end of the road for your recovery, as you have the legal right to dispute your claim denial. However, without the help of a trusted team of workers’ compensation attorneys, your future efforts may land you in the same position you are in now.

At Midwest Disability, we have been helping our clients receive the compensation they need and deserve, to return to their pre-accident lifestyles. The burden that being unexpectedly injured puts on your shoulders is more than enough to worry about, let us work with you to help get you on the path to recovery. Call us today 888-351-0427 to learn more about how we can help, over a FREE consultation.


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