My Work Injury is Obvious: Why Were My Workers’ Compensation Benefits Denied?

  1. Worker's Compensation
  2. My Work Injury is Obvious: Why Were My Workers’ Compensation Benefits Denied?
workers' compensation benefits

When you suffer an injury at work, you naturally expect your Workers’ Compensation benefits to come through without issue, especially if the injury seems clear-cut. Unfortunately, claims can sometimes be denied, leaving injured workers confused and frustrated. Understanding the reasons behind these denials can help you navigate the process more effectively and ensure you receive the benefits you deserve.

The Armstrong Law Firm, PLC, reviews some reasons Workers’ Compensation benefits are denied and how we can help you get what you deserve.

Common Reasons for Denial of Workers’ Compensation Claims

Workers’ Compensation claims are denied on a regular basis, mostly for small omissions or inadequate information. Common reasons that your Workers’ Compensation injury claim may be denied include:

  1. Failure to Report the Injury Promptly: One of the most crucial steps after an injury is reporting it to your employer. Oklahoma requires you to report the injury within one year; certain illnesses or exposures to work-related hazards have other reporting time deadlines. It’s always best to report any injury immediately. Delaying this report can lead to automatic denial of your claim, regardless of how obvious your injury may seem.
  2. Insufficient Medical Documentation: Even if your injury is evident, you must provide adequate medical documentation to support your claim. This entails seeing a medical professional who can evaluate your injury and provide a detailed report. If the insurance company deems the medical evidence insufficient or not directly related to your work duties, they may deny your benefits.
  3. Injury Not Covered by Workers’ Compensation: Not all injuries qualify for Workers’ Compensation benefits. If your injury occurred during a non-work-related activity or if you were not on the job when the injury happened, your claim may be denied. For instance, injuries sustained during lunch breaks or after hours typically don’t qualify for coverage.
  4. Pre-existing Conditions: If you have a pre-existing condition that could contribute to your current injury, insurers may argue that the injury isn’t work-related. It’s essential to clearly communicate how your work contributed to your current condition and provide medical documentation to support this.
  5. Disputes Over Employee Classification: Your employment classification can affect your eligibility for benefits. Independent contractors, for example, often do not qualify for Workers’ Compensation in the same way as regular employees. If your employment status is unclear or disputed, it could lead to denial.
  6. Non-compliance with Medical Treatment: If you fail to follow prescribed medical treatments or do not fully participate in your recovery, the insurance company may question your commitment to getting better. Non-compliance can lead to a denial of benefits based on a perceived lack of effort in addressing your injury.
  7. Employer Insurance Issues: Sometimes the issue lies with your employer rather than your claim. If your employer does not have Workers’ Compensation insurance or their policy has lapsed, they might deny your claim despite its validity.

What You Can Do Next

If your claim has been denied, all hope is not lost. The Armstrong Law Firm, PLC, in Tulsa, provides seasoned, knowledgeable, and compassionate counsel and legal representation for injured Oklahoma workers to help them get the benefits they deserve under the law. Here are steps you can take to address the situation:

  • Review the Denial Letter: Thoroughly read the denial letter to understand the specific reasons provided for the denial. This will guide your next steps.
  • Gather Evidence: Compile all necessary documentation, including medical records, correspondence with your employer, and any witness statements. This information can help clarify your situation and support your appeal.
  • Consult with a Workers’ Compensation Attorney: Consider reaching out to our experienced Workers’ Compensation attorneys. We can review your case, advise you on your options, and represent you during the appeals process.
  • File an Appeal: Oklahoma allows injured workers to appeal denied claims. Ensure you follow the appropriate procedures, as deadlines for appeals are critical.

Oklahoma Workers’ Compensation Benefits Claim Appeals

Experiencing a work-related injury is a stressful ordeal, and having your Workers’ Compensation claim denied adds to that burden. By understanding the common reasons for denial and taking proactive steps, you can improve your chances of receiving the benefits you deserve. Armstrong Law in Tulsa is ready to help you and ensure your rights are protected. Call us today to schedule a free review.

 

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