It was an ordinary day at work, then you found yourself seriously injured. After seeking medical attention, you reported the injury to your employer and filed for workers’ compensation benefits. You anticipate getting the benefits you need to cover medical expenses and lost wages while you recover. After all, you shouldn’t have to pay for an injury that occurred during the course of your employment, right?
Unfortunately, that might not be the end of it. Not every work comp claim gets approved.
Why are claims denied?
There are a number of reasons that workers’ compensation insurers use to deny claims. Some of the most common include:
· Failing to report in time: Colorado has an extremely short time for employees to report an injury. Employers must be notified – in writing – within four days of an injury. Furthermore, claims seeking benefits must be requested within two years from the date of the original injury (though most people file them earlier).
· Not seeking medical treatment: If you don’t seek medical care for an on-the-job injury, it is typically not compensable.
· Your employer fights back: Some claims are denied because the employer fights them by saying the injury wasn’t incurred while the employee was performing his or her job duties, or is due solely to the fault of the injured employee (if he or she started a fight, was engaged in horseplay or was actively committing a crime, for example). An employer could also argue that the injury didn’t actually happen on the job.
Claim denials occur for other reasons as well. That being said, it’s important to realize that a denial isn’t the end of the proverbial road. Appeals are relatively common and can make a huge difference in the life of an injured worker by providing the benefits he or she desperately needs.