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Why Was My Workers’ Compensation Claim Denied?

Why Was My Workers’ Comp Claim Denied?

If you suffered a work injury or are living with an occupational illness in Maryland, you may assume that you’ll receive workers’ compensation benefits without any trouble. However, you may be unpleasantly surprised when your employer or its workers’ comp insurer denies your claim.

There are many reasons for a workers’ comp denial. If your work injury claim was rejected, an experienced lawyer can review your case and discuss your options for continuing to pursue workers’ comp benefits.

When you’re coping with a job injury or disease, you deserve a workers’ compensation attorney who listens to you, provides effective and honest legal advice and works diligently for the best possible outcome for your case. That’s what we deliver at Trollinger Law, LLC.

If your employer or its insurer has denied your workers’ comp claim, don’t wait to contact our law firm for a free consultation. We serve clients throughout Maryland and Washington, D.C.

Why Would Workers’ Comp Be Denied?

Although most Maryland employees are entitled to workers’ compensation, many people run into obstacles on their journey to benefits. An initial denial can be disheartening, but it’s not necessarily the end of the road.

Workers’ compensation may be denied if the claimed injury or occupational illness did not arise in the course and scope of a worker’s employment or if workers’ comp does not cover the claimed condition according to state law.

Workers’ comp claims can also be denied if the employee did something to disqualify themselves, such as being intoxicated on the job at the time of the accident.

In some cases, a denial results from an error or oversight by the employee in filing their workers’ comp claim. Alternatively, an employer or workers’ comp insurer may make an honest mistake in reviewing an employee’s claim, such as overlooking an important detail that makes or breaks the employee’s eligibility for workers’ comp benefits.

And unfortunately, sometimes employers and insurers issue a bad faith denial of a workers’ comp claim, refusing to assume the cost of an employee’s injury or medical condition caused by their work.

Common Reasons for Denial of Workers’ Comp Claims

Some of the most frequently cited reasons for denials of workers’ compensation claims include:

You did not notify your employer of your injury within the required time.

In Maryland, an employee has 10 days from the date of a work accident or the occurrence of a work injury to report it to their employer. For occupational illnesses, employees have one year from the date of their diagnosis or the date on which they learned that their condition was job-related to provide notice. Employees can satisfy this requirement by verbally notifying their supervisor, manager, or employer.

However, if no follow-up is made after an oral notice of a work injury, the employer or its insurer may later claim that the employee failed to give timely notice. For that reason, injured workers should always provide written notice, even if they have already verbally notified a manager or supervisor.

An approved medical provider did not treat you.

An employer may urge you to be examined by a healthcare provider of their choice. They may also provide a list of preferred providers. This is done to diagnose your condition and determine the reasonableness or necessity of the proposed medical treatment.

However, Maryland law gives employees the right to choose their provider to treat a work-related injury or illness. Denying a workers’ comp claim because you did not see a preferred practitioner is unlawful.

You never received medical treatment.

If you never sought treatment after a workplace accident or began experiencing symptoms of an occupational illness, your employer or its workers’ comp may argue you never suffered a work injury. The failure to timely seek treatment may also lead your employer or its insurer to conclude that your injury or condition was caused by something other than your job, leading to your claim’s denial.

Why Would Workers’ Comp Be Denied?

Your paperwork was late.

After you notify your employer of your work injury or occupational illness, you must submit considerable paperwork to support your claim, usually within a specific timeframe. Failing to do so may lead your employer or its insurer to deny your claim or to assume you abandoned your claim.

 

In addition, Maryland’s workers’ compensation law requires that claim paperwork be filed with the state Workers’ Compensation Commission within 60 days of the date of an injury or the discovery or diagnosis of an occupational illness. However, unless the employer/insurer can prove that they were extremely prejudiced by a filing of greater than 60 days, the claim will usually be timely. Employees who fail to file a formal claim within two years of the disease or injury will be permanently barred from pursuing compensation.

Your injury stems from a pre-existing condition.

Finally, many denied workers’ comp claims are rejected on the basis that the employee is attempting to claim an injury or illness that arises from a pre-existing condition, not from harm that occurred in the course and scope of employment. You need comprehensive medical records and evidence to argue that your condition is job-related and not caused by a pre-existing health matter.

Hire a Qualified and Experienced Workers’ Comp Attorney

A workers’ compensation claim denial can be discouraging, but it’s possible to appeal an unfavorable decision. Getting legal representation during the appeals process can help you build the strongest possible case for benefits. Contact Trollinger Law LLC today for a free case review with a trusted workers’ compensation lawyer.

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