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6 reasons workers’ compensation claims are denied

On Behalf of | Apr 23, 2021 | Workers' Compensation |

North Carolina residents who suffer injuries on the job depend on workerscompensation benefits to cover their losses and carry them through the tough times until they land on their feet again. Unfortunately, many people who apply for these benefits often get word that their requests have been denied. Here are six of the most common reasons workers’ compensation claims fail to receive approval.

Failure to report in time

Before one can apply for workers’ compensation benefits, the injury or illness needs to be reported to ones employer within a certain timeframe, generally just a few days from the date of occurrence or diagnosis. Every state has different requirements on the timeline. This notification should be in writing.

Failure to file the claim in time

After reporting to ones employer, the claim can be filed. The state sets the timeline for how long one has to file the official claim. Generally, one has 30 days after notifying ones employer, though, it could be slightly longer.

Lack of evidence

Once the claim is received, it may be denied due to a lack of evidence. A workers’ compensation provider will not cover losses if there is not sufficient evidence to prove the injury or illness was worked-related. This is why documenting what happened and seeking medical care as soon as possible is so important.

Medical treatment not needed

Not all injuries suffered on the job require medical treatment. In such cases, workerscompensation may be denied. Seeking a second medical opinion may prove helpful.

Employer dispute

Employers have the right to dispute workers’ compensation claims. They can do this if they believe the injury was not work-related. They can also do this if they believe the employees actions violated safety protocols and disqualifies them for workerscomp benefits.

The injury isn’t covered by workers’ compensation benefits

Believe it or not, not all injuries or illnesses are considered compensable under workers’ compensation benefits. Stress-related injuries or illnesses are a prime example. Every state has different rules regarding qualifying injuries and illnesses.

Achieving maximum compensation following a work injury or illness can prove challenging. North Carolina residents who feel their workers’ compensation claims were wrongly denied may appeal. An experienced workers’ compensation attorney may be able to help them do that.