Reasons Why Employers Dispute Workers' Comp Claims

Injured employees rely on workers’ compensation benefits to pay their bills and make ends meet while they recover and lose out on days, weeks, or more of work. Unfortunately, actually receiving these benefits can be challenging as employers can fight workers' compensation claims for various reasons. After finding out that their employer has disputed or denied their claim, it can be outright devastating to an injured worker’s livelihood and wellbeing. Refiling or creating an appeal may be an option but, in the meantime, the immediate impact is already felt.

Common Workers Compensation Denial Reasons

If you have been injured at work, it helps to know some common reasons why employers dispute claims so that you can hopefully avoid the same issues. At the very least, you will be better prepared to fight back if your filing is wrongfully contested.

Some common reasons, both legitimate and illegitimate, workers’ comp claims are denied include the following:

  1. Money: Workers’ compensation isn’t just handed out by an employer directly from their own coffers. It is a form of insurance they buy and pay monthly premiums to maintain. The more times the insurance company has to give them money for workers’ comp coverage, the more likely their monthly premium will increase, as it would with any other form of insurance. In order to keep that cost minimized, a dishonest employer could deny or delay claims without actually reviewing them first.
  2. Disbelief: Some employers simply do not believe that their employee who has filed a claim is being serious. Thinking that they have the final say, they may deny a claim because they don’t believe the injury is a real issue. This sort of obstacle can be presented before any worker, but it is more common in workplaces that can cause subtle yet debilitating workplace injuries, like when an accountant develops carpal tunnel syndrome or back pain from working at a computer for 40 hours a week.
  3. Location: There are instances in which an employer accepts that an employee has been injured but denies responsibility for workers’ compensation based on the location that the injury took place. If a worker is hurt while not actually at their regular place of employment, or if they are required to travel often as part of their job, such as a delivery courier or ambulance driver, it can be difficult to prove that they are eligible workers’ comp benefits.

What to Do after a Workers' Compensation Claim is Denied

If your workers' compensation claim was denied, you can file an appeal with your local Workers' Compensation Appeals Board. This will involve requesting a hearing in front of a judge at this board, where he or she will decide whether or not the insurance company must accept your claim.

Fight for Your Right to Compensation! Call for a Free Consult!

Remember that a workers’ compensation denial is not the end-all, be-all decision regarding your case. You can still use an appeal or seek justice and compensation through a lawsuit. If you live in Southern California, contact Ufkes & Bright to connect with our Santa Ana workers’ compensation attorneys.

During a free consultation, you can learn your rights and options. Have further questions? Check out our frequently asked questions page.

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