For most of us, it is traumatic enough just to have an injury at work. But, experiencing a denial of benefits from your employer or your employer's insurance company can make the situation a great deal worse. In addition to the potential significant financial hardship that a worker would face, there is also a good deal of stress, confusion, and sometimes anger.

There can be many reasons for a denial of benefits. When faced with the prospect of a denial, an injured worker might first be prompted to think that his or her employer is thinking that the case is fraudulent. While there are, unfortunately, many fraudulent cases filed each year, there are many other reasons for having a claim denied, and many of them are purely administrative in nature. In the Workers' Compensation system, there are very specific rules that must be followed, deadlines to meet, and forms to be completed. If any of these items are incomplete or improperly submitted, your chances of having a claim denied are greatly increased.

All employers and insurance companies must follow state laws and guidelines when evaluating a Workers' Compensation claim. An insurance company has the responsibility to promptly notify a worker of a denial claim within 21 days of receiving the claim. The company must submit a Notice of Denial to the worker. If they fail to do so, they can be held responsible for interest, penalties, and attorney fees.

It is not uncommon for an insurance company to deny just a portion of your Workers' Compensation claim. In their Notice of Denial, they must fully and clearly state which benefits they are denying and their reasons for doing so. If the denial is for purely administrative reasons (for example, missing information on a form), a call to the insurance company could correct the matter quickly and efficiently. There will be instances, however, when you will need to consult an attorney to ask for expert advice on how to deal with a denial of benefits.

Some reasons include:

· Failure to report the incident to the employer.

· Failure to report incident to the employer in a timely manner, or in the amount of time required by the employer.

· Little or no medical treatment was sought by the worker.

· Injury is related to a pre-existing condition.

· Incomplete paperwork.

· Suspicion of fraud.

· Discrepancies in the story.

· No witnesses.

Failure to report the incident to the employer in a timely manner

Even if you did report the incident to your employer, the failure to do so in a timely manner can create problems. An insurance company might issue a denial of benefits if you have not filed your claim within the required timeline set forth by your employer.

Little of no medical treatment was sought by employee

If a worker does not seek medical attention for their injury, it will, sometimes, become an issue for concern by an insurance company. It will depend on a variety of factors. For example, if a worker claims to have seriously injured his or her back in a fall but did not seek any medical attention at all, an insurance company will be inclined to deny any benefits until an injury can be conclusively proven. In addition, such an example will also cause an insurance company to suspect fraud. While there are instances where medical treatment is not necessary, a worker should always seek medical attention if he or she has been injured.

Injury is related to a pre-existing condition

Incomplete paperwork

Although it seems like common sense to fully complete all important legal forms, many people do not do so. Some people might erroneously think that certain sections of a form are optional when they are not, or they may simply forget to complete all required information. Such a denial can easily be corrected, and timely attention to such matters will greatly enhance your ability to successfully file a Workers' Compensation claim.

Suspicion of fraud

There are many warning signs of fraud that an insurance company looks for when processing a Workers' Compensation claim. Although the vast majority of claims are valid, some people attempt to abuse the system. An insurance company will look for warning signs such as evidence that an employee is engaged in activity that is inconsistent with an injury. A severe back injury claim by a person who has been observed doing suspicious activity will result in a denial of benefit and even potential prosecution. An insurance company has the right to conduct business by ensuring that all claims are fair and truthful, and they will use their resources to verify the validity and accuracy of all Workers' Compensation claims.

Discrepancies in the story

If a Workers' Compensation claim contains any discrepancies, it is likely that an insurance company will deny a claim. For example, if one claims to have been injured during a particular timeframe in one narrative statement, but informs the insurance company in a later statement that the injury occurred at a different time, this is a discrepancy. Even if the discrepancy is minor, it will be a cause for concern for an insurance company.

No witnesses

Although witnesses are not absolutely required to successfully file a Workers' Compensation claim, the lack of witnesses will occasionally raise some concern for an insurance company. It will depend on a variety of factors. For example, if you claim to be injured in a room that was filled with fellow co-workers but you have no witnesses to your injury, this will cause an insurance company to question the validity of your claim. But, there are instances when there are no witnesses to an accident, and this is not an absolute necessity.

Inadequate details

All Workers' Compensation claims must be fully detailed in its scope. All details must be presented and communicated to both your employer and your employer's insurance company. If your description of the accident or injury lacks some pertinent information, an insurance company will deny your claim until it receives the proper documentation.

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