As we mentioned above, workers’ compensation is supposed to be an easy way for workers to get their at-work injuries covered, but unfortunately, it’s not always that simple. Although this system removes the question of fault (with few exceptions), the insurance company may find other reasons to deny your claim, such as:
Your treatment wasn’t authorized. In an emergency, you should be able to go to an emergency room and receive treatment right away. If your situation is not an emergency or you need non-emergent follow-up care, you must use an approved medical provider. Your employer should have a list of these providers available and a number you can call 24/7 to access this information. However, even with an approved provider, you may have issues with the insurance company claiming that the treatment you need is unnecessary.
Your injuries were due to your own reckless or intentional behavior. Workers’ comp insurers can’t deny your claim just because you made a mistake that led to your injuries. However, they can deny your claim if your actions were excessively reckless or if you injured yourself on purpose. For example, if you were driving drunk and caused a car accident while working, they could deny your claim. This is why most employers require drug and alcohol testing after any workplace accident.
Your injuries were pre-existing, fake, or otherwise unconnected to the work accident you reported. Your denial may claim that you weren’t really hurt or are exaggerating the severity of your injuries or that you had them prior to the accident, so the insurer doesn’t have to cover them.