Most common reasons for workers’ compensation claim denials

Florida’s warm weather and theme parks attract visitors from around the world, encouraging on-going construction projects. From the creation of new hotels and rides to freeway projects, thousands of workers lift, crawl, crouch and pull to their physical limits every day. These strenuous activities can result in injuries, no matter how careful the workers are or how safe the environment. 

According to Payscale.com, correctly filing a workers’ compensation claim requires attention to detail. Some employees who qualify for compensation receive coverage denial. Here are some of the most common reasons claims are not accepted. 

Reporting Delay – The more time that goes by between the accident and official notification to your employer, the more challenging it becomes to prove the injury occurred on the job. If significant time passed between the incident and informing your employer, you may receive claim denial. 

Injuries unrelated to job duties – If you had an accident at work, but outside the scope of your job requirements, your injuries may not qualify for workers’ compensation. For example, you and your colleagues set up a basketball net on uneven ground. During a quick game at lunch, a co-worker went in for a slam dunk, landed awkwardly and broke his ankle. The injury occurred outside job duties, and likely does not qualify for workers’ comp. 

Using an out-of-network doctor – For claim coverage, the doctor who treats your injuries must be an approved physician in your employer’s insurance network. If he or she is outside that network, you may be liable for the related medical expenses. 

Incomplete Reporting – You must provide full details, including a list of aches, pains and injuries. Describe the situation that caused the damage and circumstances surrounding it to the doctor. If you leave out important points, you may lose some treatment coverage. 

Visit our webpage for more information on this topic.