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Winter is not quite over yet, and snow and ice still cause injuries, especially to people trying to work. According to a recent study, an employee's compensation claim for snow or ice-related injuries averages $ 48,000. So it's no wonder that insurance companies want to refuse an occupational accident claim if they can. Here are some common reasons why you claim to be rejected.
If you are injured on the job, workers may refuse if no one witnesses the accident. The insurance company may not believe that you have been injured, or that the injury was related to work, if no one else can confirm it. Employees who report their injuries immediately and tell everyone the same story are more likely to be believed.
Many insurance companies will refuse a claim if your injury is unexplained. It can be as simple as not giving a reason for a fall. You need to be able to say that you tripped over a office carpet or there was a puddle of water in the middle of the floor for the injury to be explained.
Often times a claim can be denied if you have a pre-existing condition or injury. If you've always had a bad back, an insurance company can say that lifting a heavy box didn't cause a back injury - they will say your bad back caused it.
No medical documentation
Medical documentation is required to be injured at work. If you do not see a doctor or go to the emergency room, you will not be compensated. Insurers will also deny claims after seeing a doctor, but they haven't seen the documents to prove it. Usually you will need to sign a waiver or have documents sent to the insurer. You can also decline a claim if your medical records do not match your injury report or what you told your staff.
No injury report
In many states, you must file an injury report with your employer within 7 days of an accident in order to receive employee compensation. Insurance companies and employers become wary of an employee who claims they were injured much later than in an incident or if they don't tell anyone at work.
Not on the clock
If you were technically unavailable, if you were away for work, or if you traveled to work or back in the event of an injury, your claim may be denied.
Regardless of work
If you are injured while on the job, you may not be able to collect compensation if illegal drugs are found in your system. An insurance company can say it was the medication, not a fall on ice, that caused the injury. You can also be turned down if you are injured while you are exercising during your lunch break. The injury would be a result of exercise and not a work item.
You have taken unnecessary free time
Injuries can cause you to miss out on work. However, an insurance company will refuse a claim if you take unnecessary time off. If you do not need treatment or rest recommended by a doctor, but still choose to stay home from work, you may not be eligible for employee compensation. Often times, you will need medical records showing how much work you are going to miss.
What can you do if your claim is denied?
Unfortunately, insurance companies often try to turn down claims. If for any reason your claim is denied, you can certainly fight it. The best way to do this is to seek help from an employee compensation law firm. An employee's attorney can determine the next best step. A worker's attorney can even contact the insurance company for compensation without going to court. Often times, insurance companies choose to pay a claim as soon as a worker's attorney is involved. A worker's attorney can also help you if you are faced with fraudulent termination.
Work accidents can be especially difficult for people. Not only are you faced with pain and a lack of work, but you are also dealing with an insurance company unwilling to pay you. Be sure to see a doctor, file an accident report with your employer, and speak to an employee representation attorney if your claim is denied.
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