Why Are Workers’ Compensation Claims Denied?

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  2. Why Are Workers’ Compensation Claims Denied?
Why Are Workers’ Compensation Claims Denied

Oklahoma employers are responsible for helping protect their employees from the financial hardships associated with a work-related injury. If an Oklahoma worker is injured, wrongfully killed, or develops an occupational illness while performing a job-related task, their employer (and their employer’s insurance company) evaluate the work injury claim and approve or deny coverage. But what does this type of claim cover, and why are workers’ compensation claims denied?

What Does an Approved Workers’ Compensation Claim Cover?

When an illness or work injury claim is job-related and meets eligibility requirements, the injured employee often receives coverage for the costs of a variety of medical expenses related to the injury. Medical expenses typically covered include ambulance transport, necessary surgeries, physical therapy, and medications. Some workers’ comp claims may even cover a portion of the worker’s lost wages due to recovery time. Workers who suffer more severe workplace injuries may receive additional, permanent compensation benefits like job retraining or ongoing supportive medical care coverage.

5 Common Reasons Oklahoma Workers’ Compensation Claims are Denied:

However, coverage is only possible if the workers’ compensation claim is approved. Let’s go over some of the most common reasons Oklahoma workers’ compensation claims are denied.

  • The Injury was Not Work-Related
  • The Injured Worker Did Not Receive an IME (Independent Medical Examination)
  • The Injured Worker Never Took (or Failed) a Drug Test
  • The Injured Worker Did Not Notify (or was late notifying) their Employer
  • The Required Workers’ Compensation Paperwork was Late
  • The Employer Does Not Have Workers’ Compensation Insurance

What is Considered a “Work-Related” Injury for Workers’ Compensation Claims?

An Oklahoma employer’s insurance company may deny a work injury claim if they find that non-work-related elements caused the injury or illness. If any of the following apply to your workers’ comp claim, the insurance may use it as a basis for denying your claim:

  • You have a pre-existing health condition.
  • The injury happened outside the scope of your employment or while driving to/from work.
  • The injury occurred during an unpaid break.
  • The injury occurred while the worker was “messing around” or engaging in horseplay.
  • Drug or alcohol use can be seen as a significant contributing cause of the injury.
  • The injury is “faked.”

To avoid a denial based on these factors, carefully document the details leading up to the injury and what took place after the injury (or illness). Supporting documentation is a great help when showing you were injured while on the clock. It’s also an advantage to have an experienced workers’ compensation attorney on your side.

What is an IME or Independent Medical Examination?

An Independent Medical Examination (IME) is an exam performed by an authorized third-party medical provider. The IME is a requirement to establish a diagnosis of the injury from an unbiased source. An IME may be ordered by the Workers’ Compensation judge if a dispute arises or when there are conflicting medical opinions during a workers’ compensation hearing. A request for an IME may also be mutually requested by both parties involved. However, if the judge orders an IME, and the injured worker does not complete the exam as requested, they may relinquish the right to receive benefits due to an obstruction of the mandatory exam process.

Did Your Employer Request that You Take a Drug Test?

Many employers will request that the injured worker take a drug test after a workplace injury. Refusing to complete the requested drug test or failing the drug test may lead an insurance company to deny the workers’ compensation claim. However, a positive drug test after a workplace accident does not bar all claims under Oklahoma’s workers’ compensation laws. For the insurance company to deny a workers’ compensation claim due to a positive drug test, they must also establish that the drug use was a significant cause of the accident.

Did You Notify Your Employer of the Injury On Time?

Injured workers must notify their employer of any on-the-job injuries within 30 days of the incident. The workers’ compensation claim may be denied if the employer does not receive notification within this timeframe.

Did You File Your Workers’ Compensation Claim Late?

After a workplace injury, you must file a claim with the Workers’ Compensation Commission. The claim must be filed within one year of the date of the injury or within six months of the last medical treatment provided by workers’ compensation, whichever is longer. Failing to do so before the deadline may result in a denied Oklahoma workers’ compensation claim.

Does Your Employer Have Workers’ Compensation Insurance?

Unfortunately, some employers don’t carry workers’ compensation insurance. Nearly every employer in Oklahoma is required to have workers’ compensation coverage. In some circumstances, certain employees in Oklahoma may be exempt from workers’ comp coverage, such as:

  • Sole proprietors
  • Members of a limited liability company (LLC) who own at least 10% of the capital
  • Members of a partnership
  • Stockholders (owning at least 10% of capital)
  • Family businesses with five or fewer family-related employees

Unfortunately, not all businesses adhere to this law. If your employer does not have workers’ compensation insurance, you still have legal recourse to seek benefits for your workplace injury or illness. Contact an experienced Oklahoma workers’ compensation attorney to discuss your options.

Despite these common reasons why an Oklahoma employer may deny your workers’ compensation claim, you could still receive fair compensation for your on-the-job injury. A skilled workplace injury lawyer knows how to evaluate workplace injury claims, assist with filing an appeal, or fight a denial on eligible worker’s comp claims.

If you are injured on the job, you have the right to receive compensation for your losses. Get in touch with Armstrong & Vaught, PLC, Premier Workers’ Compensation, Employment, and Social Security Law Firm. We are devoted to providing excellent legal services to clients from all walks of life. Contact us online or call (918) 582-2500 to schedule a free initial consultation with an experienced attorney.

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