Reasons Workers’ Compensation Claims are Denied
March 16, 2017
Workers’ compensation claims can be disputed for several reasons. For those who have to deal with a disputed claim, it may be necessary to take legal action to obtain the benefits you deserve.
There are many reasons that insurance companies representing employers may deny a workers’ compensation claim in Arizona.
Below are the top five reasons that workers’ compensation claims may be disputed in Arizona.
Problems with Paperwork or Deadlines
To receive workers’ compensation benefits, you must comply with certain conditions when filing a claim.
This includes bringing the claim within one year of when the work injury or illness first occurred. Any claim filed after the one-year deadline will not be considered to receive workers’ compensation benefits.
The sooner you file your claim, the better chance you have at receiving full benefits. Claims that are filed closer to the deadline may create the impression that your injury is not as serious as you allege.
Properly filing the appropriate workers’ compensation forms is vital as well. All paperwork must be filled out correctly and have the proper signatures.
Any questions or concerns regarding the process to properly file a workers’ compensation claim can be directed to the Industrial Commission of Arizona’s (ICA) Claims Division.
However, the ICA can only guide you through the paperwork portion of the claims process and cannot offer you legal advice. If you are in need of legal consultation for a denied claim, you will need to contact an experienced Phoenix workers’ compensation lawyer.
Injuries from an Off-Site Accident
If you were injured in an off-site accident, you may still be eligible for workers’ compensation benefits. Claims concerning an injury you received while performing a job-related task, such as traveling to a meeting or transporting goods and cargo may still be covered.
However, if you were injured in an off-site accident that occurred outside your normal work hours or outside the duties of your job, your claim may be denied. This can include being in an accident during your daily commute to or from work or if you are injured after leaving your job site for a non-work-related reason.
Arizona is a no-fault state when it comes to workers’ compensation claims. This means that workers are entitled compensation for lost wages and medical treatment regardless of whether they caused their injury.
However, there are certain behaviors that would disqualify a workers’ compensation claim, such as:
- Engaging in misconduct
- Putting themselves purposefully in danger
- Intentionally injuring oneself
- Engaging in dangerous activities not related to his or her job duties
- Working under the influence of drugs or alcohol
If an employee participates in any of these behaviors, he or she severely jeopardizes his or her eligibility to receive benefits through workers’ compensation.
Pre-Existing Condition or Prior Injury
Those who have a pre-existing injury or condition may have a difficult time proving the validity of their claim.
Insurance providers who handle workers’ compensation claims often check applicants’ past medical records. If there is any evidence that your injury may have occurred at an earlier time other than your work-related accident, your claim may be disputed.
Minor Injury or Completely Healed
Many are under the impression that only the most serious injuries are covered by workers’ compensation. This, however, is not true and delaying seeking medical attention may worsen your condition.
Workers are encouraged to see a doctor or physician for any injury as soon as possible regardless of its severity.
Seeing a doctor directly after the injury occurs can also provide a marking point in which the doctor can observe the injury and determine if you should be compensated.
Having a doctor perform an early examination of your injury will also make it easier to receive an extension of your benefits.
If you are attempting to be completely healed through workers’ compensation benefits, you will need a doctor’s approval. By seeing a doctor immediately after suffering the injury, he or she can recommend an extension of your treatment based on your injury’s progress.
However, if a doctor reports that your injury is completely healed, an insurance provider will end your benefits. This decision can be appealed, but you must have sufficient evidence proving your injury is still in the healing process and requires further medical treatment.
Experienced Legal Help
At Phillips Law Group, we understand the frustration that Arizona’s workers go through when their workers’ compensation claim is denied. We know that you need the benefits provided by your employer in order to fully recover and continue supporting yourself and your loved ones.
Our Phoenix workers’ compensation lawyers can help you file a claim to ensure that all requirements and deadlines are met. If your claim is denied, we can help you file an appeal to increase your chances of receiving the compensation you deserve. Do not hesitate to contact us for a free, no-obligation consultation to discuss your claim.
For experienced legal help with Arizona’s workers’ compensation claims, call 1-800-706-3000 .
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