Worker’s Compensation provides reimbursement for medical expenses when an employee has a job-related injury or illness. The right to reimbursement requires the employee to give up the right to file a lawsuit against the employer with regard to that particular injury. There are some circumstances where an employee may not be covered, even after suffering a qualified injury. For example, if the employee was injured while under the influence of alcohol or drugs or while committing a crime, the claim will be denied. This is just one common example. In reality, workers compensation claims denied by insurance carriers may have been rejected for a number of reasons, many of which can be avoided.
Failure to provide prompt notification of injury
Employees are required to immediately notify their employer of a work-related injury. If notice cannot be provided immediately, it must be provided as soon as reasonably possible. Each state has its own time limits for reporting injuries, but usually employees have 30 days to notify their employers.
Failure to timely file your claim
A common mistake employees make is missing the deadline for filing a worker’s comp claim. Giving your employer notice of an injury and actually filing a claim with the insurance carrier are two separate things. There is a statutory deadline or “statute of limitations,” for filing your worker’s compensation claim. Your claim can be denied simply on the grounds that it was not filed with the statute of limitations period.
The statute of limitations for submitting a workers’ compensation claim in Arkansas is two years from the time you become aware, or should have been aware, that you have an employment-related disease, or two years from the date that you are injured. In Missouri, however, a claim must be filed within two years of the injury, or one year from the last date that the employer made a payment related to the work related injuries, whichever is later.
The claimed medical condition is not covered
The most common types of medical condition not covered by worker’s compensation insurance are mental health related. In fact, most workers’ comp claims based on a mental health issue are initially denied. While most states cover conditions such as post-traumatic stress disorder (PTSD), other conditions must be linked to a specific event experienced while working. In some case, conditions such as depression and severe anxiety, may be covered. The problem comes in establishing that your mental health issues are directly linked to your job duties.
The injuries are not sufficiently serious
In order to be covered, you must establish that your injury limits or completely prohibits you from performing your job duties. For example, if you injury your back while loading boxes, but the pain is only temporary, your claim will probably be denied. The fact that you may feel your injury is debilitating is not the issue. You must prove the extent of your injury to the insurance company, typically through the opinions of a physician.
If you have questions regarding denial of claims, or any other worker’s compensation issues, call the Cottrell Law Office at (888) 433-4861.
He is licensed to practice law in the United States District Court for the District of Kansas, eastern Arkansas, western Arkansas, and western Missouri. He was Deputy Prosecuting Attorney in Crawford County, Kansas from 1987-1989.
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