It’s not uncommon for an injured employee to be denied workers’ compensation benefits after filing a claim. Sometimes, denials are made in error or because of inadequate evidence.
In other cases, the employer or insurance company may try to deny benefits simply because they do not want to deal with the expense of paying the worker and they think the employee doesn’t have the fortitude or wherewithal to fight back. Below we discuss some common reasons for a denied workers' comp claim. Walker, Billingsley & Bair can fight back if you are wrongly denied benefits.
Of course, some workers’ comp claims are legitimately denied. When employees fabricate or greatly exaggerate their conditions, they obviously should not be granted benefits. Also, employees who were intoxicated at the time of the accident and injury may not be entitled to workers’ comp.
Overstepped the Time Limits
Not reporting your injury straightaway can be a problem. You should always notify your supervisor immediately when you are hurt on the job, or as soon as you recognize that you’ve developed a work-related illness or condition. You have 90 days to file a workers comp claim in Iowa. Failure to do so could thwart your rights to benefits.
Plus, the longer you wait to report your injury, the more likely the insurance company will use the delay to negate your illness. They might say that if the condition was real or serious, you would have earlier reported it to your employer.
Medical Authorization Issues
When a worker refuses to sign a medical authorization, the insurer may deny the claim. The workers’ comp laws surrounding medical authorization are confusing. Your employer’s insurer is entitled to review your medical records for your work-related accident. However, you are not legally mandated to sign a release that gives the insurer authority to independently obtain your medical file.
Another option is for you to obtain your record and give it to the insurer yourself; that way, the insurer doesn’t have access to your other personal medical records that have nothing to do with the work accident. Insurers are not fond of this practice, though, fearing you might only provide them with selected records in your favor. It’s best for employees to get an attorney’s assistance in such cases.
Failing to Abide By a Doctor’s Orders
If you haven’t completely stuck to your doctor’s orders, you could be denied benefits because the insurer could use your non-compliance as evidence to refute the legitimacy of your injury. The insurer can argue that if you were truly injured, then you would have adhered to your treatment plan.
They may use the following excuses to deny you're actually injured.
- You missed appointments
- You posted Facebook pics of you doing physical activities
- You refused a medical exam
- You were caught on surveillance doing things (lifting, climbing, etc.) that your injury supposedly disallows (Employers and insurers sometimes send out investigators if they believe you aren’t being truthful about your injury.)
Was your workers' comp claim denied? Speak to Walker, Billingsley & Bair in Des Moines
Fortunately, there is a workers' comp appeals process you can go through to try to obtain your benefits if you’ve been wrongly denied your workers' comp claim. You can collect and present additional evidence to demonstrate your case. It’s highly advisable to have a workers’ comp attorney help you through the process so that you are fully prepared and get the legal help you need to work towards a successful resolution.
For a free consult with a workers’ compensation attorney in the Des Moines area, call Walker, Billingsley & Bair. Contact us today at 888-435-9886 to set up a consultation to speak with one of our lawyers.