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Common Reasons Workers’ Compensation Cases Are Denied

Individuals who have sustained an on-the-job injury or illness usually have the right to be compensated for their medical bills and a percentage of their lost wages. In some cases, however, workers may receive notice of a denied workers’ compensation claim near San Jose. If this happens to you, you should be aware that you still have options. You have the right to obtain legal representation, for example. Your workers’ compensation attorney can file an appeal on your behalf.

LATE CLAIMS

After sustaining an injury or illness in the workplace, it’s imperative to take action right away. If you file a workers’ compensation claim past the deadline, it may be denied. Likewise, some employees fail to file a claim and then discover that they’re being fired or laid off. If they file the claim after this occurs, the insurance carrier may assume that it’s a “revenge claim” and lacks merit. Similarly, some workers’ compensation claims are denied because the employee did not promptly report the incident. In addition to filing a claim with the help of a lawyer, employees are generally expected to follow office procedure for reporting an incident to their supervisors or HR department. Failing to do so right away may lead the employer or insurance carrier to assume that the accident wasn’t serious or that the accident didn’t cause the injury.

RECORD DISCREPANCIES

Another reason why you might need the help of a workers’ compensation attorney to file an appeal is discrepancies between your medical records and your accident report. You can reduce your risk of a denied claim by making consistent statements to your supervisor, HR department, doctor, and all other people you talk to about the incident.

UNWITNESSED INJURIES

It’s common for an insurance carrier to question workplace accidents in which no witnesses were present. If your company has security cameras, the footage may help your case. However, if there is no way to document exactly what happened, you can protect your legal right to compensation by reporting the incident to your supervisor immediately after it happens. Making consistent statements to everyone involved will also help substantiate your case.

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