When the Worker’s Compensation system works as intended, those injured at work while engaged in the duties of their job receive benefits. It is a “no-fault” system – workers are in not required to establish that negligence led to Minnesota work injuries.
One reason that controversies about claims arise is that the insurance companies responsible for paying out benefits to often look for ways to deny claims in order to minimize expenses and maximize profits.
In practice, some workers run into difficulties when filing workers comp claims. Here are some ways your workers comp claim could be denied.
There are two key deadlines injured workers must contend with: the deadline to report an injury and the deadline to file a worker’s comp claim. The reporting requirements vary from state to state. Some require immediate reporting of an injury to an employer while others provide a certain number of days to do so. However, in practice insurance companies are often suspicious of claims involving injuries which are not immediately reported.
In general, a workers comp claim must be filed within a certain time period. This is one year in some states, although the deadline varies. However, not all injuries are clearly evident. For example, exposure to a toxic substances while on the job may not produce immediate symptoms, and an insurer may reject a claim as untimely when the worker simply did not link emerging symptoms to the toxic exposure.
When a worker is injured “off-site,” questions may arise as to whether the injury about occurred during the course of his/her employment. One gray area is traveling during the course of the workday. Injuries that occur during a commute are usually not covered, but injuries sustained while traveling from one work site to another often are.
Or, if you are conducting business as you travel from place to place during the workday, you are often covered under the state’s Worker’s Compensation laws. Nonetheless, this does not mean that an insurer might not deny a claim on the grounds that you were not “at work” when the injury happened.
If a worker suffers an injury to a part of the body which was involved in a previous injury or diagnosed medical condition, a claim may be denied. The insurer, rightly or wrongly, may point to previous medical treatments as evidence of a pre-existing condition that made the work injury more likely. that was diagnosed and/or required treatment the insurance company may seek to deny the claim.
For example, say that, years ago, you injured your lower back in the fall at home. Now, you sustain an injury in the same general area of your back while lifting a heavy object at work. The insurer may point the blame for the injury to your pre-existing condition. While a pre-existing condition does not fully disqualify a worker from receiving workers comp benefits, it is common for insurers to only cover a worsening of a pre-existing condition due to a workplace accident.
Injuries Considered Too Minor
One reason it is usually important to report an injury immediately is that, if a worker fails to do so, the insurer may later claim that the injury was not serious enough to justify medical treatment, time off or both. If a person works through the pain while on the job, only to seek treatment days or weeks later, the insurer may deny the claim.
Despite the fact that Worker’s Comp is a no-fault system, some claims are denied due to alleged worker misconduct. For example, if a worker has drugs or alcohol in his or her system, the insurer may place the blame for the injury on the person’s allegedly impaired condition. Self-inflicted injuries and those resulting from horseplay often lead to denied claims as well. Sometimes, an insurer tries to link alcohol or drug use to an injury when no real linkage exists.
If you or a family member suffers a work injury, we’d welcome the opportunity to discuss the matter with you. There is no charge for an initial consultation. We work hard to preserve our clients’ rights under the law. To learn more, please contact us.
Contact A Mankato Workers' Compensation Lawyer Today
Contact the law office of Chesley, Harvey & Carpenter today at (507) 625-3000 for a free case review. We are located in Mankato, Minnesota.