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Why Your Workers' Compensation Claim May Fail Despite Injury Proof
Admin • Feb 10, 2019
Workers' compensation insurance benefits are available to employees who get injured on the job. However, workers' compensation may deny your claim under certain circumstances, even if you got your injuries in your office. Read about some of the cases where workers' compensation may deny your claim.
Late Filing
Most states have a time limit within which you must file your workers' compensation claim. This time limit is a statute of limitations after which workers' compensation cannot accept your claim. The statute of limitations starts from the day of the accident that caused your injury.
Consider a case where you sustain an injury but don't file a claim because you don't need the money or you don't take the injury seriously enough. If the statute of limitations in the state is 12 months, then workers' compensation will deny your claim if you file it 14 months after your injury.
Short Injury
Workers' compensation insurance carriers reserve their benefits for employees with serious injuries. The rationale is that only workers with serious injuries will miss enough work days to suffer serious financial damages, which is what the insurance should pay for. In Tennessee , you can only enjoy workers' compensation benefits if your injuries last for more than 7 days.
Therefore, if you got injured on a Monday and your doctor declared you recovered by Friday, you won't get workers' compensation benefits because your injuries are short-lived. If your injuries last for more than 8 days, then you only receive the compensation for day 8 of the injury. However, if your injuries last more than 14 days, then you enjoy the compensation from the first day.
Treatment Refusal
Workers' compensation may also deny your claim if you refuse medical treatment or don't follow your doctor's orders without a good reason. If you refuse treatment or don't follow your doctor's orders, then workers' compensation assumes that further injury is self-inflicted. You will be solely responsible for such self-inflicted injuries.
For example, if your doctor orders a surgery but you refuse and opt for medication, workers' compensation can legally deny your claim. In some places, your employer has the right to choose the first doctor you see. If that rule applies in your state, you may have an option to file a request with your state's industrial commission for an alternative doctor after the first visit.
Therefore, when your employer suggests a doctor, see the doctor and follow their instructions until you can get permission to see another doctor. Don't refuse treatment even if you don't agree with the doctor on everything. If you do see another doctor, you also must follow their instructions to the letter.
Non-Compensable Injuries
Although workers' compensation compensates on-the-job injuries, the insurance doesn't cater to all injuries. Therefore, workers' compensation may deny your injuries if the injuries fall within the noncompensable ones.
For example, many heart diseases and mental illnesses are non-compensable in some states. The reason is that such injuries do not normally stem from work accidents. However, there are exceptions: Workers' compensation may compensate you for heart or mental injuries if you can prove that your employment caused them.
Disobedience
Lastly, workers' compensation may also deny your claim if you were injured because you disobeyed your employer in some way. Workers' compensation doesn't consider such an injury as an accident because you could have avoided the injury if you had obeyed your employer. An example is an injury you sustained because you were drunk on the job against company policy.
As you can see, workers' compensation has several laws they can use to deny your claim. At S.N. Anthony Insurance Inc., we have the experience to ensure workers compensation doesn't deny your claim unfairly. We can even help you appeal your claim after a denial. Contact us
today and let us help you enjoy the benefits you deserve.
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