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Why Can a Worker’s Comp Case Be Denied?

Envelope shows denied workers' compensation claim stamp.

Can My Claim for Worker’s Compensation Be Denied?

Unfortunately, claims for worker’s comp are denied on occasion. Filing a claim can be complicated in some cases, but for the most part, they are straightforward. However, after an injury, dates and specifics can become muddled, and workers’ comp claims have definite requirements. Let’s look at some of the reasons a denial is issued in a workers’ comp case.

Reasons Why a Worker’s Comp Case Is Denied

Some employers and their insurers search for reasons to deny a workers’ compensation case. While the reason must be consistent with state rules, here are a few that are commonly used:

  • The accident is not related to work: It is necessary to prove that your injury arose out of employment and occurred during a work-related activity. This includes doing something requested by the employer such as picking up parts at a local supplier. Another murky area is taking part in a company event. If you are taking part in a company baseball game as a representative of the business, then chances are it will be considered a work-related incident. An injury suffered while traveling to and from work is not covered, but if you are driving a company vehicle, it usually is. Business trips related to your work at the company are likewise covered. 
  • Misconduct: When an employee breaks a company rule and is injured in the process, chances are it may not be covered. This is especially true if the worker was engaging in joking around or broke the rule intentionally.
  • Self-inflicted injuries: Such injuries are not covered.
  • The injury may have happened somewhere else: In some cases, it is difficult to prove an injury is work-related. For instance, repetitive movements can cause carpal tunnel syndrome. However, so can certain exercises or playing tennis. In such cases, it must be proven that the injury was limited to work-related activity. Sicknesses are similar. For example, if a worker is filing a claim for an infection contracted at work or an occupational disease, it must be proven that it did not happen outside of work. Additionally, many occupational diseases can be contracted in the past but remain asymptomatic for years such as asbestosis.
  • Missed deadlines: There are deadlines for filing. Generally, you must report the injury as soon as possible after it occurs. This way your claim is protected. 
  • You quit your job: Let’s say you quit your job, were fired or were laid off after the injury but before you filed. Most of the time, the worker’s comp claim will be denied. However, there are nuances. For instance, you might be fired as soon as the injury occurred because a shady employer knew the work area was not safe. An attorney would look for previous occurrences and dispute the denial.

Morris Law Firm in South Carolina

Don’t give up if your worker’s compensation claim was denied. The Morris Law Firm in the Myrtle Beach area is ready to help. Call us at (843) 232-0944 to schedule a free case review. You can also reach out to us online.

MORRIS LAW FIRM - MYRTLE BEACH OFFICE
2411 N. Oak Street, Suite 403A 4th Floor
Myrtle Beach, SC 29577
(843) 232-0944

MORRIS LAW FIRM - MURRELLS OFFICE
11054 SC-707
Murrells Inlet, SC 29576
(843) 232-0944

Call us now for a FREE consultation!