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The most common reasons why workers’ compensation claims are denied

On Behalf of | Dec 13, 2021 | Workers' Compensation, Workers' Compensation Process |

If you have suffered an injury while carrying out your work duties, your entire life has likely changed. You need those workers’ compensation payments to help you deal with the medical expenses, missed wages and other costs associated with your injury, so that you can get your life back on track. Before you file, then, make sure that you understand the types of things that most often result in insurance companies denying workers’ compensation claims.

The injury occurred outside of work duties

New York’s workers’ compensation statute clearly establishes that injuries only qualify for coverage if they occur in the course of one’s work duties or arising out of the conditions of one’s employment. In other words, you must have been engaged in work duties at the time of your injury for it to qualify.

Insurance companies often disqualify injuries that they think occurred due to horseplay or fooling around on the part of employees, or while not strictly engaged in their work duties.

A missed deadline

The workers’ compensation claims process has many strict deadlines. The first deadline you will come up against after your injury is the requirement for informing your employer of your injury. If you do not properly disclose your injury within 30 days – or if you miss any other deadlines – the insurance company will have the justification they need to deny your claim.

Pre-existing conditions

Most of the time, a medical examination will clearly reveal that the source of an employee’s injury was their workplace accident. Occasionally, however, insurance companies will find a pre-existing condition in the employee’s medical history that they can blame the injury on, and that they can use as justification for denying the claim.

If you live in the Capital District or upstate New York, and you are thinking of filing for workers’ compensation, don’t hesitate to contact Silverman, Silverman and Seligman PC. We only get paid if we recover benefits for you, so you have nothing to lose. Call today to schedule your free consultation.

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