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When can workers’ comp deny your claim?

On Behalf of | Apr 7, 2023 | Workers' Compensation |

Workers’ compensation is a type of employer-sponsored insurance that’s designed to provide much-needed benefits to workers who are injured or sickened as a result of their jobs.

Unfortunately, the system doesn’t always work the way that it’s expected. Legitimate claims are denied all the time for one reason or another.

What are some of the most common reasons given for a denial?

While the specific rules and regulations governing workers’ compensation can vary by jurisdiction, there are some common reasons why a claim may be denied:

  1. Failure to report the injury or illness in a timely manner. In Illinois, employees must report their injuries or illnesses within 45 days after they occur. Any delay can potentially compromise your claim, but exceeding the time limit can lead right to a denial.
  2. The injury or illness did not occur while you were working. Workers’ comp benefits are only available for injuries and illnesses that arise out of and in the course of employment. If your employer believes you were injured on your own time, they may seek to deny the claim.
  3. The injury or illness was self-inflicted. This doesn’t simply mean that you accidentally injured yourself, but that you are accused of purposefully injuring yourself for some reason, like putting your fist through a glass door in anger.
  4. The injury was caused by horseplay or misconduct: If you were injured while playing a prank on your co-workers, for example, that could be a reason to deny your claim.
  5. The injury or illness is not covered under the workers’ compensation policy. For example, psychiatric injuries are not always covered under workers’ comp benefits unless they can be tied to a specific place, time or event at work.

It is important to note that just because a claim is denied does not mean that it cannot be appealed. Employees have the right to challenge a denied claim through the workers’ compensation appeals process. Experienced legal guidance can help you build your case.