Valid workers’ compensation claims sometimes get denied for simple problems. It is important that you meet the strict requirements for filing if you want to start receiving your benefits sooner and without the hassle of trying to appeal. This article discusses some of the most common reasons an initial claim for benefits may be rejected.
If your claim has already been denied, it is important that you seek legal advice from an experienced Knoxville workers’ compensation lawyer as soon as possible. The legal team at Greg Coleman Law is well-versed in Tennessee state laws and welcomes the opportunity to review your claim in a free initial consultation. Since we accept workers’ compensation cases on contingency, no upfront fees are charged to you if we represent you. We do not get paid unless you do.
Missing a Deadline
To be eligible for workers’ compensation benefits, you must report a work-related injury or illness to your employer in a timely manner. In Tennessee, the deadline to report an injury is 15 days from when it was sustained, or from the date a doctor tells the worker that his or her injury or illness is work-related.
However, not informing your employer about an injury immediately after happens may provide an opportunity for him or her to suggest you were hurt somewhere other than at work. Additionally, reporting any injury right after it happens may speed up the claims process and enable you to start receiving benefits sooner. Missing the deadline, however, will probably lead to a denial.
Differences Between the Accident Report and Medical Records
A common reason why a workers’ compensation claim may be denied is when there are conflicting statements between the accident report and the claimant’s medical records. This might happen when an injured worker gives one version of events on the initial claim forms but then leaves out certain details that may not seem relevant when speaking to a medical provider.
However, for the sake of a workers’ compensation claim and to avoid this as a reason for denial, it is important that you give the same information about the incident and how you were injured to your supervisor, claims adjuster, doctor and any others involved in processing your request for benefits.
You Were Off the Clock or on a Break
To be eligible for workers’ compensation benefits, your injury must have occurred while you were performing work-related duties on your employer’s job site or while you are off site but performing an assignment under your supervisor’s directions.
If your injury is not work-related, such as getting hurt in a car accident while driving to work in the morning, your injuries may not be covered. However, there are exceptions when being hurt off-site may still be covered. For example, if you were instructed to pick up lunch for a client meeting and were injured in an accident while on this employer-instructed task, you may be eligible for benefits.
Workers’ compensation claims are often complicated. This is why it is a good idea to call an experienced Knoxville attorney for legal advice about your specific situation.
The Condition Is Not Related to Your Work
In Tennessee, workers’ compensation benefits are available to an injured worker when an authorized treating physician has determined that his or her injury is work-related. If you were hurt off-site during an activity that was not related to your employment, your claim can be denied.
Likewise, if you were at your job but involved in an activity that was not within the scope of your employment, your claim could be denied. For example, if you were injured in an act of misconduct, such as fighting, you may be denied any benefits.
The workers’ compensation carrier can also deny claims that are based on pre-existing injuries. If your injury is due to a medical condition that existed before your current job, the claim may be denied as a non-compensable injury.
To receive workers’ compensation benefits, you will need to provide evidence to support your claim, including:
- Witness statements about how the accident occurred
- Medical records that link your injuries to the accident
- Medical opinions from an independent medical examination
Contact a Skilled Lawyer to Help with Your Claim
If you were hurt on the job and need assistance with your workers’ compensation claim, contact Greg Coleman Law for assistance and a free review of your claim. Our compassionate legal advocates are prepared to help you with every step of the Tennessee workers’ compensation filing process.
We charge no upfront fees and receive no payment at all unless we are successful in obtaining compensation on your behalf. The clock is ticking, so call us now to get started and to find out how we may be able to help.
You can reach us 24/7 at (865) 247-0080.