Why was my workers’ comp claim denied?

On Behalf of | Oct 8, 2018 | Workers' Compensation |

The last thing you need after you have suffered a workplace injury is to receive a letter from your employer’s insurance company denying your claim for workers’ compensation. Workers’ compensation is supposed to provide coverage for your medical bills, lost wages and other expenses related to a work injury, and you were likely counting on that coverage to see you through until you can return to work.

Of course, you have every right to appeal the denial, and you would be wise to seek the assistance of a workers’ comp attorney to help you with that complex process. Your attorney can review your case and help you understand the reasons why the insurer denied your claim. Knowing the reason for the denial of the claim will help you determine your chances of a successful appeal.

Bad faith or valid denial?

An insurance company, like any business, exists to make money. Likewise, your employer may be more focused on keeping insurance premiums low than on seeking the best for his or her workers. These factors may lead to bad faith denials of valid claims for coverage. On the other hand, the insurer may be within its rights to deny a claim under these and other circumstances:

  • You missed the deadline for reporting your injury to your employer. In Illinois, you have 45 days.
  • You missed the time limit for filing your claim with the insurer. Your employer may have offered to do this, but it is always a good idea to file on your own or with the help of an attorney.
  • Illinois workers’ compensation law will not cover injuries that occurred at voluntary company social events.
  • You did not require medical treatment for your injury.
  • You required treatment but failed to follow through with your doctor’s orders.
  • You did not submit enough evidence to prove your injury occurred at work.

This final point may be especially difficult to overcome if your employer has disputed your claim that your injury occurred on the job. If your boss insists your injury resulted from horseplay or intentionally trying to harm someone else, you may need to prove otherwise. Finally, most workers’ compensation insurers will not cover injuries that occur if a worker was intoxicated or under the influence of drugs at the time of the injury.

To appeal the denial of your claim, you are up against more deadlines and paperwork. You may need to gather additional documentation of your medical care or even find witnesses to corroborate your version of the events. An experienced workers’ compensation attorney can assist you with every aspect of your appeal.

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