Why Do Workers’ Comp Insurers Deny Worker Claims?

Published on Jul 22, 2022 at 11:00 am in Workers' Compensation.
Why Do Workers’ Comp Insurers Deny Worker Claims?

If you were injured on the job, you know that recovery can consume your entire life. On top of your pain and suffering, you may be dealing with steep medical bills, loss of the ability to work, and frequent trips to the doctor or therapist’s office. Workers’ compensation exists to help defray some of these costs. When your injury arises through the course of your job, your employer’s workers’ comp insurance should help cover the medical bills and loss of wages resulting from your injury.

But what happens when your claim is denied by your company’s workers’ compensation insurer? How can you recover the compensation you need to afford medical care when the insurance company refuses to accept your worker claim? We know that this situation happens all too often in Gulfport, MS.

A Gulfport workers’ compensation lawyer from Corban Gunn, Attorney at Law can help protect your rights in an unfair situation like this. We know what excuses insurance companies use to deny claims—and we refuse to accept invalid reasons for refusing to pay our clients what they deserve. Your workers’ comp lawyer will make sure that you are treated with dignity and fairness after your injury.

So, why do workers’ comp insurers deny worker claims? The reasons are rarely based on good intentions.

Reasons a Workers’ Comp Claim May Be Denied

We all know that an insurance company is a business. Workers’ comp insurers are no exception. Many of the reasons for denying worker claims are motivated by profits. It makes business sense for a company to actively look for details, technicalities, ambiguities, and oversights that can be used as reasons to deny compensation. Insurance adjusters are specifically trained to seek and identify reasons to reject a claim.

Some of the reasons workers’ comp insurers deny worker claims include:

  • Missed Deadlines. The employer and their insurer might argue that you didn’t report the injury or file your claim within the mandatory deadlines. We know that deadlines are not always as cut and dried as they seem. For example, some workers aren’t aware that they suffered an injury until some time has passed. We can look into your case to see if the insurer is justified in denying your claim based on a missed deadline.
  • Preexisting Medical Conditions. One tactic often used by workers’ comp insurers is to allege that your injury wasn’t caused by your accident but actually existed prior to it. Some insurance adjusters may even try to obtain your medical records unrelated to the accident. They’ll then use these older records to look for information that can be used to prove the injury was preexisting.
  • Denying the Accident Was Work-Related. Determining if an accident is work-related can be somewhat of a gray area. What if you were in an accident while driving to a work meeting? What if you fell down your stairs while working from home? By formulating an argument in just the right way, the insurer may be able to claim that the accident wasn’t work-related at all. Part of the job of your workers’ comp lawyer is to make sure that you can provide solid evidence that your illness or injury did, in fact, come through the course of your employment.
  • Lack of Witnesses. What happens if no one saw the accident that caused your injuries? In the eyes of some workers’ compensation insurers, if no one saw it, it didn’t happen. Without a witness to your injury, you will need a good deal of documented evidence to prove that what you claim happened actually happened. It’s also essential that you report the accident immediately. If security camera footage is available, that can be an effective form of proof. Your workers’ comp lawyer will be able to find the evidence you need to validate your claim.
  • Inconsistency in Reports. If there are inconsistencies in varying reports of the accident, this may be cited as a reason to deny a claim. For example, the physician’s reports may indicate that the injury occurred in a different way than you reported it did. A coworker might describe the circumstances differently from another coworker. You could post on social media about the accident in a way that contradicts or calls into question details of the incident. Sometimes you don’t even realize these inconsistencies. For these reasons, it’s important to make sure you never change the facts in your account of the accident. You should also avoid social media while your claim is being processed.

What To Do After Your Workers’ Comp Claim Is Denied

If your claim is denied, it’s not the end of the road. Injured employees whose claims are unreasonably rejected have the option to take further action. When a workers’ compensation claim is denied, a worker may appeal through a process of filing a petition with the Mississippi Workers’ Compensation Commission. The process may involve a hearing and further appeals. In some cases, a lawsuit may be the best way to ensure that you are fully able to recover your losses.

If this sounds like a complicated path to go at alone, you’re right. There’s no requirement that you must hire an attorney to work with you through the appeals process—but it will significantly increase your chances of a favorable outcome. It also takes a great burden off your shoulders to know that every action will be handled with expertise and care.

Your Gulfport workers’ comp lawyer from Corban Gunn, Attorney at Law can anticipate and avoid potential obstacles to your full and fair compensation. You don’t have to second guess every decision you make in the appeals process. When your financial security is on the line, turn to an expert. You can trust the experience and skill of an attorney who has been winning maximum compensation for injured workers in the Mississippi Gulf Coast region for over a decade.

We can help you fight a denied workers’ compensation claim. If you’ve faced challenges in your effort to secure the compensation you need to recover from your workplace injuries, contact us today. We’ll start with a free case evaluation at no cost to you.





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