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Why did my Employer Deny my Workers’ Compensation Claim?

Why did my Employer Deny my Workers’ Compensation Claim?

If you work for an employer that provides workers’ compensation coverage and you suffer an injury or illness on the job, you should expect to receive benefits for medical treatment, lost wages, [1] and other relevant compensable losses. However, too often, an injured employee files a claim for workers’ compensation and receives a denial of part or all of their claim. Such a denial can be stressful as a worker then has to figure out how to cover medical bills and stay in control of their finances while they recover from their injury. However, many denials are not valid and can be challenged through the Delaware workers’ compensation appeal process. Anyone who has been denied should consult with a workers’ comp lawyer who understands your rights under Delaware law.

Common reasons cited for a denial

When your employer or the workers’ compensation insurance company decides to deny your full claim, you should be informed of the denial and relevant reasons in writing. Some of the more common reasons cited in a denial letter include:

• You did not actually suffer a serious injury or illness
• Your injury did not occur in the workplace or was not otherwise work-related
• Your injury does not require medical treatment
• Your injury does not require time off work

Simply because your employer or its insurer makes the above statements does not mean they are necessarily true, however, and you will have the chance to present evidence to the contrary if you appeal the denial.

Reasons an employer may wrongfully deny a claim

Since an employer pays for workers’ compensation coverage, you may wonder why one would ever wrongfully deny a valid claim. Unfortunately, there are several reasons that may be behind these denials. First, your employer may simply be trying to save money. Just like your auto insurance premiums go up when you make a claim for an accident, a company’s workers’ compensation premiums may increase based on certain claims. For example, an insurer may raise the rates if a worker has a particularly costly claim or if the number of injured workers is more than originally estimated for a period of time. In many situations, your employer or the insurance company may have investigators monitor your actions to try to find evidence that your claim is not entirely valid.

Another reason why an employer may deny a claim is bias against certain medical conditions or certain employees. Many employers are skeptical of medical claims that do not arise out of a single traumatic event or that cannot be concretely verified by medical testing. Repetitive stress injuries, such as carpal tunnel syndrome or back injuries from repeated heavy lifting, can develop over a period of time with no single identifiable point of origin. Employers may deny such claims since they cannot determine one exact cause of injury or may try to claim that the injury actually arose from activities outside of the workplace. In addition, some injuries may lead directly to chronic pain, which cannot be diagnosed through concrete medical imaging tests. Employers often believe that employees who suffer from such inexplicable pain are simply malingering, or feigning their pain simply to get out of work with no financial repercussions.

Some employers may believe that an injury is legitimate but may still deny a claim due to bias against the employee. If that bias is rooted in race, color, national origin, religion, age, genetic information, sex, pregnancy, marital status, gender identity, or sexual orientation, a denial constitutes unlawful employment discrimination under Delaware law. [2] If that bias is for another reason, you can still fight the denial by presenting evidence that your claim was valid during the workers’ compensation appeal process.

Contact a Delaware Workers’ Compensation attorney for a free consultation

If you have received a workers’ compensation denial, your first step should be to consult with an experienced workers’ compensation lawyer. An attorney can evaluate your situation, determine whether the denial is wrongful, and help you appeal the decision. The appeal process is complicated and representation of a knowledgeable workers’ comp attorney is imperative throughout the process. Additionally, if you have suffered an injury, you should seek assistance with the workers’ compensation claim process to ensure your claim is complete and accurate to prevent a denial in the first place. Call the Delaware law firm of Zavodnick, Zavodnick & Lasky, LLC today at 302-364-6047 to help ensure you receive the benefits you deserve today.
[1] http://dia.delawareworks.com/workers-comp/documents/Workers%20Compensation%20Rate%20Chart.pdf
[2] http://delcode.delaware.gov/title19/c007/sc02/



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