Reasons why workers’ comp claims get denied

| Feb 15, 2021 | Workers Compensation

Workers’ compensation provides workers in New Jersey part of their salary while they heal from work-related injuries. Workers’ comp relieves employers of liability because the employee cannot sue them after accepting it. However, when a worker files a claim, it may get denied for many reasons.

Injury not reported on time

A claim often gets denied if the worker failed to report the injury on time. The success of claims depends on accident investigation, and waiting interferes with the process and delays it. Many states have their own time limitations on how long employees have to file claims.

Injury not treated by approved provider

Workers commonly get a choice of approved physicians who may not be their primary doctor. The employer requests these doctors to get an unbiased examination of injuries.

Each state sets its own requirements, so it could also restrict the number of doctor visits. Some states allow the employee to choose their own doctor, but their primary doctor may not take workers’ compensation cases or treat certain injuries.

Employee termination and drug and alcohol use

Employees who get fired or laid off rarely qualify for benefits because the insurer could look at the case as just being for revenge. Even if they have a legitimate injury, an employee sometimes gets fired or laid off before they can file a claim. An employer cannot fire an employee while they receive workers’ compensation or for filing a claim.

Workers who show a blood alcohol content level above 0.08 at the time of injury commonly do not qualify for worker’s compensation. Intoxication may also include being impaired by any amount of legal or illegal drugs.

Workers’ compensation claims should be approved with no issues for employees who meet eligibility. However, when a worker runs into trouble with an employer or their claim gets denied, they may need an attorney to help them understand their options.

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