Texas Workers' Compensation
Written by AskTheLawyers.com™
Top Reasons Why Your Workers’ Compensation Claim Could Be Denied in Texas
If you have been injured or developed an impairing medical condition at work, you may be considering filing for a workers’ compensation claim. While injuries and medical conditions sustained at work can cause severe emotional distress as well as financial difficulties due to your inability to work, your claim can still be rejected. If your workers’ compensation claim has been rejected, you may have the opportunity to re-file or remedy the error. However, this depends on why your claim was rejected in the first place. Here are some of the most common reasons as to why a workers' compensation claim could be denied.
The Main Reasons for Rejected Claims
It is without a doubt that most Texas insurance companies will search for any and all possible reasons to deny a workers’ compensation claim. These rejections, however, must follow both state and federal laws. There are very common reasons as to why a workers’ compensation claim can be rejected. A few reasons include the following:
1. You filed for a workers’ compensation claim after the company’s time restriction
If you have been injured at work or have otherwise developed a medical condition due to your workplace atmosphere, you will want to file for a workers’ compensation claim. Receiving benefits from the claim can greatly help your economic status in the event that you have high medical bills and are unable to work. You should know, however, that if you have missed a deadline in your filing process, you might lose some benefits. In the worst-case scenario, you will not be able to collect any of the workers’ compensation benefits.
In order to avoid this misfortune, you first must begin by notifying the appropriate supervisor immediately after the illness or injury occurred. Once you have done so, depending on the rules and regulations of the region in which you are filing, you or your employer will need to file a workers’ compensation claim. It is important that you know your state’s rules and regulations for filing. Every jurisdiction will have different deadlines that you must abide by. If you missed the deadline, that could result in rejection.
In order to prevent a rejected claim based on time restrictions, contact an experienced attorney. A qualified personal injury attorney will know when it is appropriate to submit the paperwork for filing a claim. He or she will be able to direct you through the process and make sure that you do not miss any deadlines, which could jeopardize your ability to receive workers’ compensation benefits.
2. There is a debate whether your work-related injury actually occurred at your place of work
There are several reasons as to why this argument can be presented. A few of the most common reasons include:
- You were not on the clock when the injury or ailment occurred;
- You were involved in misconduct when the incident took place; and/or
- Your medical condition did not arise from your workplace exposure.
With any of the above reasons, in order to dispute the rejection, you will need to gather sufficient evidence that will demonstrate your validity and otherwise support your claim. You can do so by collecting:
- Medical records that demonstrate the relationship between your ailment and your work history;
- Co-workers or other eyewitness corroborations that can support your claim;
- Work time cards, which demonstrate that you have worked during the questioned hours.
3. Your medical condition does not meet the required guidelines
Unfortunately, Texas guidelines do not cover all medical conditions. Your medical condition may be regarded as being too miniscule to qualify for benefits. The duration of your injuries may also be a contributing factor to a rejected claim. Be sure to check with Texas’s specific regulations to determine if your conditions qualify for workers’ compensation benefits.
4. You filed for a workers’ compensation claim after you left your employment
It is usually the case that an insurance company will deny your workers’ compensation claim if the claim was filed after you quit your job, were laid off, or were fired. You might have the opportunity to contest the claim denial if you gave notice of the injury before your last day at work. Certain states have special rules in regard to filing for a workers’ compensation claim after you have left your employment. If you qualify for an exception, you may have the opportunity to appeal your rejected claim.
What to Do If Your Workers' Compensation Claim Is Denied
If your workers’ compensation claim was denied, it is important that you do not give up your right to your benefits. The rejection could be due to a simple error on either your behalf or the insurance company. Contact a professional attorney who has experience in the matter and can help you appeal the decision.
In the event that you decide to appeal a rejected claim, be aware that the process can vary by region. Speak to an attorney as soon as possible to make sure you meet all your deadlines. The help and guidance of a knowledgeable and experienced attorney will also be able to help you understand if appealing your denied claim is the best option for you.
There are many reasons why a workers' compensation claim could be denied, and appeals are complicated ordeals. They often involve rules of evidence and other civil procedures that a judge will likely expect you to understand. An experienced workers’ compensation attorney can help you build a strong case. Speak to a qualified legal professional to give your claim the best chance at being successfully approved.