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Reasons why workers’ compensation claims get denied

| Mar 22, 2021 | Workers' Compensation

Workers in Eden Prairie, Minnesota, who get injured on the job may claim workers’ compensation for some injuries. Workers’ compensation pays a worker a portion of their salary until they recover. Employers offer it in exchange for not being sued for injuries, but claims frequently get denied for many reasons.

Injury and claims not reported or filed on time

An individual must report his or her injuries within a certain time frame in order to receive workers’ compensation benefits. Most states give employees 30 days, but some states may give less time. Otherwise, the provider will think the employee didn’t really get hurt.

Employees also have a deadline for filing the initial claim, which differs from reporting the injury. In Minnesota, workers have six years from the date of their injuries to file a claim.

Injury not related to job

Workers’ comp only covers injuries that happen while on the job or “within the scope of employment.” For example, a worker who falls picking up his or her personal P.O. box mail likely won’t be covered.

The other two factors that apply include “arising from” and “in the course.” “Arising from” refers to tasks or activities that benefit the employer, and “in the course” refers to the timing and location.

Sometimes, “in the course” does not mean the injury was sustained “within the scope of employment.” For instance, if an employee gets into a physical fight with a co-worker over non-work-related issues at a company event, the injury will likely not get covered.

Condition or injury not covered by workers’ comp

Most states don’t offer workers’ comp for soft-tissue injuries even if a worker must miss several days of work. Examples of soft tissue injuries include repetitive stress injuries, such as carpal tunnel, or a simple back sprain. If an employee had drugs or alcohol in his or her system when the accident occurred, the injury may not get covered.

Some states offer coverage for post-traumatic stress disorder or other stress-related conditions caused by the job. Even in the states that offer coverage for stress-related illness, the employee must prove the job caused it.

Many workers’ comp claims get denied initially for no reason. If someone feels unfairly denied, he or she should seek the help of an attorney for help with filing an appeal.