Why Was Your Colorado Workers’ Compensation Claim Denied?
7 common reasons for a denial of workers’ compensation benefits
Colorado workers get hurt on the job every day. In some cases, they may not even realize they can file a workers’ compensation claim. Even worse, there are times when a valid claim is denied for seemingly no reason. If you feel that you should have received workers’ compensation after an injury but your claim was rejected, then there may be extraneous circumstances.
Here’s a list of several mistakes, errors and unfortunate circumstances that could have led to the dismissal and rejection of your workers’ compensation benefits.
1. You or your employer waited too long to report the injury
Your employer should never “sit on it” when “it” is your injury claim paperwork. As soon as the accident happens, you should report it to your supervisor or human resources. If you don’t have a human resources department and work for a smaller business, then you can go to your supervisor or anyone in charge. Keep in mind that the longer you wait to report your claim, the more likely it is to be denied.
2. You didn’t go to the doctor right away
For a workplace injury claim to have validity, you have to get a medical diagnosis. You must report it to human resources and get medical treatment as soon as possible. If you need to go to the emergency room, then you should be taken there immediately.
Your claim may not receive validation if you don’t see a doctor soon after the injury. The insurance company may argue that the accident was caused by something other than a work injury, or that your injury wasn’t as severe as you claim since you waited to seek medical attention.
3. There were no witnesses
The insurance company may dispute the validity of your claim based on a lack of witnesses to the accident. If you are injured while working alone, then it may be more difficult to prove that the injury occurred at work. If there are witnesses, it is best practice to have them provide witness statements or incident reports to further validate your claim.
4. Your employer won’t listen to you
Perhaps the accident happened while your supervisor was away or they gave you the runaround when you tried to talk to them about the accident. Unfortunately, this is not an uncommon experience. You should immediately speak to an attorney if you feel that your employer is trying to evade you or get out of reporting your accident in a timely manner.
5. You have a history of prior injuries
Insurance companies may look into whether or not you have previously filed a claim for workers’ compensation benefits. In most cases this isn’t an issue, but in some lines of work, accidents happen more often. Especially if you have previously injured the same body part, the insurance company may try to deny your claim, arguing that you simply suffer from a pre-existing condition.
In addition, you could be accused of faking an injury, which is why medical documentation after an injury is especially important. You should retain an attorney if your claim is disputed based on this accusation.
6. You failed a drug or alcohol test
Insurance companies often try to deny claims or limit the benefits payable under a claim where the injured worker was believed to be intoxicated at the time of the accident. In Colorado, even those who consume legal marijuana may have their benefits reduced after a positive finding on a drug test, even if the marijuana was consumed long before the injury occurred. If you fail a drug test after your injury, you will likely need an attorney’s assistance to help you prove an entitlement to benefits.
7. Your employer alleges that the injury wasn’t work-related
Sometimes the reason for a fall or other medical event is seemingly unexplained. For example, if you faint or suffer a stroke while at work, the insurance company may argue that the event was unrelated to your employment, and that it was merely a coincidence that it occurred during work hours. In other cases, you may suffer an event like a stroke or heart attack at home as a result of an exposure you faced on the job. Insurance companies are likely to deny these types of “unexplained” falls or medical events, and you will need an attorney to help overcome the denial.
Was Your Workers’ Compensation Claim Denied?
If your claim has been denied, you should know that it’s extremely difficult to change an insurance company’s mind without help from an experienced workers’ compensation lawyer. You don’t have to take “no” for an answer. Be proactive by seeking advice from an attorney who can challenge the reasons why your benefits were denied.
Time is of the essence when it comes to successfully filing a workers’ compensation claim. Since certain situations or injuries are more complex within the law, it’s greatly beneficial to have an experienced workers’ compensation attorney on your side.
