9 common reasons why Montana workplace injury claims are denied or challenged
Workers’ compensation insurance is a type of policy that helps employees that are injured at work. However, like many other types of insurance claims, workers’ comp claims can also be denied.
Understanding why your workers’ comp claim was denied is essential. Many times, the denial is a result of something straightforward and simple to correct. But in some cases, the rejection is much more complicated and will require extensive legal heavy lifting to fix.
If you want to know how to fight a workers’ comp claim denial, the simple answer is with quality legal representation. All rejections are entitled to an appeal. Enlisting the help of an experienced Montana workers’ comp attorney gives you the best possible chance of success with your claim.
Top reasons why workers’ comp claims are denied
Has your claim been denied? Don’t despair. You’re not alone.
Here are common reasons why workers’ compensation claims are denied in Montana:
1. Incomplete, inaccurate or late paperwork
If your paperwork is not filled out completely or accurately, the insurance company will deny your claim. If your employer files the paperwork late, your application can also be denied. Compliance with deadlines and accuracy of paperwork does not guarantee that a claim will be approved, but it reduces denials and delays in your claim.
2. The injury occurred during your lunch break
If you were at lunch when the accident occurred, there is a chance that the claim will automatically be denied. It is critical that you speak with an attorney about this scenario. There are many factors to be considered that could qualify this injury to fall under the workers’ compensation guidelines.
3. You were under the influence
If it is discovered that you were under the influence of drugs or alcohol while on the clock, your claim will automatically be denied. Most employers require an immediate drug and alcohol test after a workplace injury occurs.
4. You didn’t report the injury when it happened
If you were injured at work and failed or forgot to report the injury at that time, your claim might be denied when you try to make a claim later. In the opinion of the insurance company, the injury could have happened at any time or in any place since it was not officially reported when it occurred. It is always in your best interest to report any type of injury immediately after it happens.
5. You didn’t receive medical care from an authorized treatment center
Your employer and their workers’ compensation insurer will have specific healthcare providers that you must use to get treatment for your work-related injuries. If you go to the hospital or doctor that is not approved by the carrier, payment for that treatment may not be covered and you have the potential of having your entire claim denied.
One exception is emergency medical care. If your injury is severe and you require emergency treatment, then visit your nearest emergency room as soon as possible. In most cases, emergency treatment is covered by workers’ compensation.
6. Your injury was caused by horseplay at work
If you and your coworkers were goofing around at work and you got hurt, then the employer and the insurance provider may decide to deny your claim. In the opinion of the insurance carrier, you were not performing your job duties at the time the accident occurred. If they can prove this to be true, then your benefits might be denied.
7. Your employer disputes the accident or injury
If you file a claim for an injury that occurred on the job and your employer states that it didn’t happen the way you said in your report, your insurance company can deny the claim. Your employer must agree with your statement for a valid compensation claim.
8. Your injury is connected to a pre-existing condition
If you have a pre-existing condition or a previous injury and your new claim is for a similar injury or an aggravation of that injury, the insurance company might deny the claim. The insurer will likely fight this type of case aggressively to prove that any injury you received is due to the prior condition or injury — not a result of your work.
9. You didn’t hire a workers’ compensation attorney to represent your case
The best thing that you can do for your workers’ compensation claim is to hire an experienced and knowledgeable attorney to manage your case right from the start. Your attorney will make sure that all paperwork is filed promptly and correctly. They can also make sure that you receive all of the necessary medical care and benefits that you are entitled to under the terms of the policy and state law.
What to do if your workers’ comp claim is denied
If your case is denied, your attorney can help you establish a solid appeals case so that your benefits are reestablished. Your attorney can also negotiate with the insurer for a settlement once your treatment is completed.
If you have already been denied for workers’ comp, don’t panic. You can still contact a workers’ comp attorney and begin building your appeal. An attorney can help at any point in the workers’ compensation process.
If you’ve suffered an injury while on the job, our expert lawyers at Murphy Law Office are ready to help you. We are trained and experienced with workers’ compensation cases and can fight for the benefits you deserve.