Common Reasons for Workers’ Comp Denials
Common Reasons for Workers’ Comp Denials
Under Alabama law, most employers are required to carry workers’ compensation insurance that provides employees with benefits if they are injured in an on-the-job accident. In addition, this insurance will provide benefits if a worker develops an illness or medical condition as a result of their working conditions.
Unfortunately, many workers’ compensation claims are denied. Some of the most common reasons are explored below, and if you have recently had a claim denied, you should contact a Montgomery workers’ compensation attorney as soon as you can.
Failing to Notify Your Employer
Alabama workers’ compensation laws require an employee to notify their employer of an injury or medical condition within five days. This is a very short timeframe, especially when you are dealing with the aftermath of an injury and undergoing medical treatment. However, if you do not notify your employer by this deadline, the workers’ compensation insurance company can deny your claim.
Your Injury Was Not Work-Related
The primary requirement to be eligible for workers’ compensation benefits is that your injury or illness happened or stemmed from the course of your employment. Insurance companies often try to characterize an injury as not work-related in an attempt to avoid paying benefits. For example:
- If you claim you injured your back at work, the insurer might allege that your injury happened while doing household chores.
- You suffered injuries in a car accident while driving to another worksite, but the insurance company claims you made a personal stop, so it was not part of your employment.
You want help from a lawyer to prove that your injury was work-related and that you deserve workers’ comp benefits.
Pre-Existing Conditions
If you have pre-existing medical conditions, the insurance company might try to deny your claim. For example, if you had back problems and previously received treatment, then you re-injure your back at work, the insurer might claim this is all the same previous injury. You must provide proof that your work-related injury is distinct and separate from your pre-existing injury. You can also show that the workplace incident worsened a prior injury, leading to the need for medical treatment that you otherwise would not have needed.
Employee Misconduct
If an injury stemmed from the injured employee’s own misconduct, the insurance company will likely deny the claim. For example, if an employee is under the influence of alcohol and drugs, and their intoxication leads to an accident and injuries, the insurance company will deny workers’ compensation benefits. Sometimes, employers might claim an employee’s misconduct was to blame - when in reality, there was another cause of the accident.
Speak with a Montgomery Workers’ Compensation Attorney
The Law Office of Richard F. Matthews, Jr. Attorney at Law handles workers’ compensation claims and appeals for injured workers in Montgomery and the surrounding areas. If you need help filing a claim, we are ready to assist. If you learn that your workers’ comp claim was denied, never delay in seeking legal help from our firm. Contact us today for more information.
The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. We invite you to contact us and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. These recoveries and testimonials are not an indication of future results. Every case is different, and regardless of what friends, family, or other individuals may say about what a case is worth, each case must be evaluated on its own facts and circumstances as they apply to the law. The valuation of a case depends on the facts, the injuries, the jurisdiction, the venue, the witnesses, the parties, and the testimony, among other factors. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.
The Law Office of Richard F. Matthews, Jr. serves Montgomery County, Pike County, Elmore County, Autauga County, the River Region of Alabama and throughout the State of Alabama, including Montgomery, Troy, Wetumpka Prattville, Selma and Tuskegee. No attorney-client relationship is established by requesting a consultation or emailing Attorney Richard F. Matthews, Jr.. Information submitted in such communication is not privileged and may be subject to disclosure.
