5 Reasons the Insurance Company Will Try to Deny Your Workers' Compensation Claim

Insurance companies are often out to make filing a workers' compensation claim difficult. The insurance company will take advantage of the fact that you do not know all of the proper steps to take when filing a worker's compensation claim to receive benefits. In reality, there are specific rules you must follow to be approved for workers' compensation benefits, but without knowing what the steps are it is easy to make a simple mistake that will result in a denial from the Virginia Workers' Compensation Commission. To help you avoid denial I'll tell you about the five easiest mistakes you can make that may ruin your workers' compensation claim.

1. The Claim Was Not Filed During the Allocated Time Frame

5 Reasons the Insurance Company Will Try to Deny Your Workers' Compensation ClaimIn most cases, this will be within two years, but consult with your workers’ compensation attorney to know the exact deadline to file a claim. The Virginia Workers’ Compensation Commission is unforgiving and once the deadline has passed there is no convincing them for an extension. Be careful not to be misled by the insurance company because they will willingly give you money for two years, but this is not the same as receiving full worker’s compensation benefits.

2. The Employer Was Not Informed of the Injury in a Timely Manner

In Virginia, your employer must be notified within 30 days of the injury. Some companies have a policy that you must notify them within 48 hours of the injury. This is not a sure-fire way for the insurance adjuster to deny a claim, but he or she will make it extremely difficult. Remember to always research your company’s injury policy and if an injury happens to you, immediately report it and document the event in writing.

3. Willful Misconduct

Willful misconduct means that you are responsible for your on-the-job injury. For example, if an employee came to work under the influence and hurt him or herself, the claim will be denied. But the insurance company will stretch situations to claim willful misconduct. They will take advantage of any break in the rules.

An example of this is going one mile over the speed limit may be grounds for a willful misconduct claim, even though the injury would have been sustained going one mile slower. Another example of common willful misconduct is when an employee is not following the company’s safety policy, but the safety policy is not enforced, and no one really follows it. It is difficult to prove the enforcement of safety policies so make sure you always follow the rules so that if you are injured, willful misconduct cannot be claimed. If this has happened, it is still possible for an attorney to fight against this claim and for you to receive benefits.

4. Employee Misrepresentation on Application

This may only apply if the misrepresentation can be proven to be connected to the injury sustained. For example, if the employee does not tell the employer about issues with his or her back, and that person hurts their foot, then the insurance company cannot deny benefits because of application misrepresentation.

5. The Person Seeking Benefits is Refusing, or Failing, to Complete Certain Requirements

One way of doing this is “refusal of employment.” If a doctor says that the injured person can do a certain type of job, the person on or seeking benefits must take that job, even if they do not like the work. Refusal of employment could also mean not actively searching for employment, which goes against the benefit requirements. This can still be claimed if the person is looking for employment but is not documenting it as well.

Another less common type of refusal is “refusal of medical treatment.” This can be caused by failing to properly follow up with doctor appointments and phone calls or not following complete doctor instructions. Some people may blatantly refuse treatment if it involves surgery or blood transfusions. It is important to speak to an attorney about the reasons for refusing medical treatment, so the benefits are not revoked.

Ben Glass
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Ben Glass is a nationally recognized Virginia injury, medical malpractice, and long-term disability attorney