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Common reasons for denying workers' compensation claims

While some employees who suffer on-the-job injuries never have any complaints about treatment at the hands of a workers' compensation provider, many employees receive far less than they deserve for a claim, or see their claims denied outright.

If you recently suffered an injury on the job, you should remain mindful of any interactions you have with representatives of your employer's insurance provider. Just like car accidents or other personal injury claims, the insurance provider's representative is generally looking for any reason he or she can find to reduce payout for the insurer.

Workers' compensation can offer many great benefits when the system works, but often the system seems to work for everyone except an injured employee. Before you speak to a representative of your employer's insurance provider, consider a consultation with an experienced workers' compensation attorney. Such an attorney can help you understand exactly what you should expect from your claim and protect your own interests and rights as you work to resolve the claim and recover from your injury.

Why might a claim get denied?

There are many reasons why an insurer may attempt to deny your claim. Sometimes, these are legitimate reasons, such as denying fraudulent claims, and sometimes claims get denied on procedural grounds. If you want to get the most you can out of your claim, you must make sure that you not only have a strong claim to begin with, but make sure that you follow proper procedures for filing the claim.

If an insurance company can reasonably argue that a claim is either not work-related or does not qualify as a work-related injury, it probably will. This is most common in instances when employees attempt to defraud an insurer by either engineering the injury in the first place, or by reporting an injury that does not actually require medical attention.

Similarly, if an employee suffers a legitimate work-related injury but does not flow the proper guidelines for reporting and filing the claim, they may get denied on technical grounds. Be sure you understand the statute of limitations surrounding your injury claim so that you do not accidentally miss your window of opportunity to file the claim.

You must also notify your employer of the injury within the proper timeframe. If you do not notify your employer properly, you may endanger your chances of a successful claim.

Who should I speak to about my injury?

When your injury occurs, you should report it to your employer. In general, it is wise to report it immediately, even if it doesn't seem serious. You should also, of course, be as honest as possible when you discuss your injury with your medical care provider.

You may also discuss the issue with an attorney who represents you. Should an insurance representative want to speak to you about your claim, it is wise to simply refer him or her to your attorney and let the attorney protect your interests.

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