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Can Workers Compensation Benefits Be Denied?

Can Workers Compensation Benefits Be Denied?

Knowing that their employer has workers’ compensation insurance is a huge relief for a lot of employees. However, in the unfortunate event that a claimant has to take advantage of an employer’s policy, he or she might be surprised to find out that not every claim is actually approved. 

Reasons for Workers’ Comp Claim Denials

With few exceptions, the state of Missouri requires nearly every employer to carry workers’ compensation insurance to protect employees in the event of a work-related injury. However, there are many black, white, and gray reasons why employers, attorneys, and insurance companies might deny a claim, including: 

  • The injury isn’t covered. Typically, injuries incurred on the commute to or from the workplace are not covered. Similarly, are injury or disability for which there is no known cause is not eligible for workers’ compensation coverage. 
  • The claimant didn’t report the injury. Anyone injured on the job must report his or her injury within 30 days. If the trauma is from an occupational disease or a cause or repeat exposure on the job, victims must report their workplace injury within 30 days of the clinical diagnosis. 
  • The claimant didn’t file the claim in time. Employees must report work-related injuries to the Division of Workers’ Compensation (DWC) within two years after the incident or last benefit payment. This extends to three years if the injured person’s employer fails to report the injury to the DWC in a timely manner. 
  • The claimant was under the influence. Of course, alcohol and illegal substances are strong grounds for an outright claim denial. Sometimes, however, employers and insurance companies will attempt to use reported prescription medications as a source for workers’ compensation claim denial. 
  • The claimant ignored medical treatment and advice. In the state of Missouri, employers are entitled to assign the physician in a workers’ compensation case. Therefore, if an employee fails to inform his or her employer about the decision to seek separate medical treatment, it can weaken his or her workers’ compensation claim. 

Fighting a Denied Workers’ Comp Claim 

Not all workers’ compensation claim denials are deliberate. When you receive your denial notice, there should be a summary explaining why your specific claim wasn’t approved. Sometimes, a misfiled piece of paper or a simple mistake that’s out of your control can get in the way of your settlement. Other times, claims are unjustly denied or undervalued by design. 

The unfortunate truth is that employers want to save money, so they will try to minimize the severity of your claim, demand even more evidence that your injuries are work related, or attempt to deny cases for any number of just or unjust reasons. To prevent your employer, insurance company, and their representatives from cutting your fair compensation, you’ll need a smart lawyer fighting in your corner. The knowledgeable and experienced lawyers at Lanzotti & Rau are ready to step in the ring. 

Workers’ Compensation Attorneys in Missouri 

Being injured at work can sometimes make it harder for you to actually get back to work. If you were involved in an accident and hurt on the job, contact the legal team at Lanzotti & Rau. We work to protect claimants under the Workers’ Compensation Act and strive to settle for nothing but the best. For more information or for a free consultation on your workers’ compensation case, call us today at 573-335-9300.