Workers’ Compensation Claim Denied? This Could be Why

21 August, 2017

Workers’ Compensation exists to support those who suffer a workplace accident, repetitive stress injury, or work-related illness injury or illness at work. Unfortunately, some of these claims are denied either by the employer or the insurance company.

While there are processes of negotiation, conciliation and arbitration to resolve and appeal a rejected claim, it is helpful to understand the main reasons a claim is denied.

Employer Dispute
Many of the workers’ compensation claim disputes are not actually from the insurance company but the employer. If they doubt the conditions surrounding an incident, they may deny a claim. These reasons may include:

  • They don’t believe the injury was sustained while at work
  • The injury was on the premises, but not during normal work operations
  • They believed the claimant was under the influence of drugs or alcohol
  • There was a pre-existing condition involved
  • They question the severity of the injury
  • Failure to Report On Time

One of the most common reasons an employer denies an injury is work related is failing to report it on time, which is immediately, on the same day at the very least.  For example if an injury is sustained on a Friday but is not reported til Monday morning, a cloud of doubt may arise over the claim under the presumption the injury occurred over the weekend.

If you are injured on the job and think your injury might cause you to miss work or require medical care, tell your supervisor and fill out an accident report IMMEDIATELY.

No Witnesses

Unfortunately, either the employer or the insurance company can deny a workers’ compe
nsation claim if there weren’t any witnesses to the injury. There are exceptions to this, especially if the injury was a severe injury and it was obvious how it happened.

If you do not have a co-worker or customer as witness to your incident, report your injury IMMEDIATELY to your supervisor and fill out an accident report with a detailed account of the situation.

There Are Discrepancies

Another reason an insurance company may deny a workers’ compensation claim is if there is a discrepancy between the medical records and accident report. The statements made on the accident report must be truthful and in detail.

If what you write on the report in regards to the injury and severity is different from what your medical records state, your claim might be denied. Honesty is always the best policy.

While the vast majority of workers’ compensation claims progress to the satisfaction of all parties involved, including the injured worker, the employer and their insurer, occasionally parties need assistance to resolve disputes to a claim. You can access WorkCover WA conciliation and arbitration services here.

Receiving a denial letter is certainly frustrating, but it doesn’t mean you should stop fighting for the workers’ compensation benefits you deserve.

If you have any further questions relating to this process, please contact our office on (08) 9581 4339. We provide an initial consultation at no cost to discuss your current claim and possible entitlements.  We also act on a no win no fee basis if we are able to assist with your claim.