Workers’ compensation exists to protect employees if they are unable to work due to a work-related injury, and employers from being sued for those injuries. Most work-related injuries and illnesses are covered by workers’ comp, but there are some exceptions. Further, even claims for covered injuries and illnesses may be denied due to application errors, untimely filing, or other issues. You may find the following information helpful if yourhas been denied.
When a workers’ comp claim is denied, the claimant receives a letter informing him of the decision. One of the most common reasons for denial is untimely reporting or filling. When an injury or illness occurs, the law holds that the worker must report the claim right away, often within days. It is then the employer’s duty to immediately notify its workers’ comp carrier and the state. Failure to follow these steps precisely may result in a denial.
My Employer Disputed My Claim
This is another common reason for a denial. Let’s say you claim that your back injury is work-related, but your employer thinks you actually sustained your injury playing basketball. She might dispute the validity of your claim, which could result in a denial. If this occurs, you may need to gather additional evidence to substantiate your claim.
My Condition is Not Covered
Although most on-the-job injuries are covered by workers’ comp, there are some exceptions. If your injury is not serious enough to qualify, or the condition itself isn’t covered, your claim may be denied.
In MA, an injury that occurs outside of the scope of your job duties may not be covered. For example, if you and a co-worker decide to hit some golf balls in the field outside your office building, you aren’t likely to have a workers’ comp claim if you accidentally get hit in the head with a golf club. You may have been at work, during work hours, but hitting golf balls isn’t a work-related activity. The same would be true if you were inside the building at the time of your injury. On the other hand, if the same injury occurred at a golf course, during a work outing at which you were entertaining clients, you would likely be covered by workers’ comp.
Even if your injury or illness occurred on work property and in the scope of your job duties, the medical condition itself may not be covered. Some mental health conditions, such as stress, may not qualify you for benefits. A Continue readingcan help you determine your eligibility for benefits.