While you may assume you'll automatically receive workers' comp benefits if you're injured on the job, but that's not always the case. There are a number of things that can cause your claim to be rejected by the workers' comp insurance provider. Here are two of them and what you can do to fight back:
You Didn't See an Approved Medical Professional
After you're hurt on the job, your natural inclination will be to get treated by your own healthcare provider. Unfortunately, this can be problematic because, depending on where you live, your employer and workers' comp can require you to be seen by a list of approved medical professionals. If you aren't evaluated by someone on the list, your claim will be denied.
This situation can present a catch 22. The doctor workers' comp recommends may not be impartial and may downplay your injuries, resulting in lower benefits or a rejected claim. However, if you aren't evaluated by the professional, your claim may be denied anyway.
You can protect yourself in a couple of ways. First, get a second opinion from a healthcare provider you trust, particularly one who specializes in the type of injuries you have. For instance, if you suffered a head injury, then get evaluated by a neurologist. A report from a specialist will often carry more weight than one from a healthcare professional who only provides general care.
Second, be sure to have a workers' compensation attorney representing you. The attorney will typically know something about the doctors on the list the workers' comp insurance company will give you and, thus, can help you choose someone who is reputable as well as push back against an erroneous report.
You Were Engaged in Horseplay or Roughhousing
Another reason your workers' comp claim may be denied is because you were injured while engaged in horseplay, roughhousing, practical jokes, or similar non-work activities. This is because your injuries must stem from work activities to be covered by workers' compensation insurance, and horseplay and roughhousing are not considered part of your duties as an employee.
However, your claim will only be denied if you are the instigator of the activity. If your coworkers start the horseplay or roughhousing and you are injured as a result, your claim should be covered. You would just have to prove you were not the perpetrator, which may be challenging depending on the situation. It's best to consult with an attorney about this issue who can help you develop a strategy for handling this particular issue.
For more information about workers' claim denials or help managing your case, contact a workers' comp law office like Prediletto, Halpin, Scharnikow & Nelson, P.S.