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Common Reasons Workers’ Compensation Claims Are Denied

Posted on November 14, 2022

If you get injured on the job in Alabama, the no-fault workers’ compensation system should make it easy for you to collect financial compensation for your medical bills and lost wages. Unfortunately, these claims are not always simple or successful without the help of an experienced workers’ compensation attorney in Birmingham. Workers’ compensation insurance companies have been known to deny claims and reject payouts for a variety of reasons – and not all of them are valid.

Dispute About the Timing

To qualify for workers’ compensation, the worker’s injury must have occurred within the course and scope of employment. If the employee was not engaging in job-related tasks at the time of injury, it will not be covered under Alabama’s workers’ compensation laws. While this does not necessarily mean that the injury has to take place in the office or on the premises, the worker must be able to prove that he or she was engaged in work-related activities at the time. Otherwise, the insurance company may deny the claim on the grounds that the injury or illness is not occupational.

Missed Filing Deadline

If you are eligible for workers’ compensation benefits, you must file your claim within the deadlines. The first deadline requires you to report your injuries to your employer right away. Your employer will fill out a First Report of Injury Form to document the event. The second deadline is the statute of limitations on filing a workers’ compensation claim in Alabama, which is two years from the date of injury or from the date of the worker’s last compensation payment. If you wait too long to seek workers’ comp benefits, the insurance company may have grounds to deny coverage.

A Non-Qualifying Injury or Illness

Workers’ compensation benefits apply to almost any occupational illness or injury, but there are some exceptions. For example, some states do not allow claims to be filed for psychological conditions or emotional stress. In addition, most one-time illnesses (e.g., a cold or flu) do not qualify for workers’ comp unless they are severe.

Pre-Existing Injury

An insurance company may try to withhold benefits from an injured worker by arguing that the claimant had the injury or illness prior to the incident (a pre-existing injury). In this scenario, the worker would have to prove that the medical condition is either new or that the work accident exacerbated a pre-existing injury in some way to qualify for benefits. Workers’ compensation will not cover a pre-existing injury, but it will if a work accident made a pre-existing condition worse.

Willful Misconduct or Horseplay

Another common reason for workers’ compensation claim denials is “willful misconduct of the employee.” If an investigation finds that the employee willfully and knowingly violated a reasonable rule of the workplace, refused to use safety equipment provided by the employer, was intoxicated from alcohol or drugs at the time of the accident, was engaging in horseplay, or was otherwise responsible for the injury due to an act of willful misconduct, this will make the individual ineligible for workers’ comp.

What to Do if Your Workers’ Compensation Claim Gets Denied in Alabama

If your workers’ compensation claim in Alabama gets denied, consult with a Birmingham workplace accident attorney for advice. Your claim may have been rejected for many reasons, from failing to seek proper medical treatment to insurance bad faith practices. Bad faith is when an insurance company wrongfully rejects a claim to save money on the payout.

An attorney will investigate your claim to determine why it was rejected. Then, your lawyer will do what he or she can to clear up the issue and change the insurer’s decision. If the insurance company is negligently or intentionally mishandling your claim, your Birmingham personal injury lawyer may be able to help you file an insurance bad faith lawsuit to pursue further compensation from the insurance company, as well. To learn more about workers’ compensation denials in Alabama, contact Drake Injury Lawyers at (205) 859-2236.