Blog

Why was my claim denied- Maryland Workers Compensation

For Immediate help from Maryland Workers Compensation Attorney Andrew M. Rodabaugh Call +1 (410) 937-1659     OR         Email

It may come as a shock to many that workers compensation claims are regularly denied by the insurance company.  If the injured worker receives a denial it is a good idea for he or she to contact a Maryland Workers Compensation Attorney for a free consultation. 

Here are 10 reasons why your claim may have been denied:

  1. The description of the accident on the claim form is not accurate or leads the adjuster to scrutinize whether the accident is one that should be covered under the work comp policy.  How the accident happened, what the employee was doing when the accident happened, where the employee was when the accident took place, and what body parts were injured all have a great affect on whether the adjuster will accept or contest the Maryland workers compensation claim.
  2. There are too many injured body parts on the claim form.  Exposure/expense to workers comp in large part depends on the body parts that were injured in the accident and how many body parts were injured.  The more body parts injured the greater the chance of denial.  It is not advisable to leave injured body parts off of the claim form, however if it may be a good idea to consult a Maryland workers compensation lawyer to determine the best way to fill out the form and if there is another way to seek treatment without adding each body part to the initial claim form.
  3. The injury was not immediately reported to the employer.  It is important that the injured employee notify the employer as soon as they are involved in a work accident.  The workers comp adjuster will often first contact the employer for verification that an injury did take place at work.  If a supervisor is not available it is a good idea to notify multiple co-workers that you have been involved in a work accident and that you are injured.
  4. Workers comp adjusters will not only deny claims but will also deny ongoing medical treatment if they do not have medical records to substantiate the injury and the necessity for continuing treatment.  While a Maryland workers compensation attorney can help obtain medical records on an ongoing basis in these cases, at the outset of the claim there is usually a month or so delay in getting the original medical records.  This will lead to the adjuster denying the claim at first only to protect that right.  The adjuster can always change their mind later on and agree to accept the claim as compensable.  Again, a Maryland workers comp attorney can be a valuable asset in getting the adjuster to accept the claim.
  5. A lack of witnesses will often lead the adjuster to deny claims because the case will then become a matter of credibility on the injured workers part.  Without any corroborating witnesses the injured worker must come off as honest and sincere at the time of the hearing or the case could ultimately be lost.  If there are indeed no eye witnesses it is a good idea to tell multiple employees about the accident.
  6. If the injured worker has a history of injury to the same body part then the adjuster may deny the claim.  The basis for this denial ultimately hinges on a medical question.  The adjuster will likely arrange an Independent Medical Evaluation (IME) in an effort to obtain an expert medical opinion as to the causal connection of the injuries sustained to the alleged accident. 
  7. If the employee has a history of multiple injuries then workers comp adjusters are more likely to deny the claim.  Despite the inherent risks in an occupation, it is the opinion of many adjusters that multiple past workers comp claims indicate that the employee may be attempting to game the system.
  8. In is inevitable that there may be inconsistencies in medical records or incident reports as to how the accident occurred.  Depending on the workers comp adjuster, even the most benign inconsistency can lead to a denial.  It is best that the injured worker right down exactly how the accident occurred as soon as practical so that they can reference that note in the future so to avoid any inconsistent statement.
  9. The employers vendetta!  Unfortunately sometimes the decision to challenge or deny a workers compensation claim is the employers decision.  While there are legal ramifications for denying claims for particular reasons denials may occasionally be issued with no explanation.  In these instances it is best to consult a qualified and experienced Maryland Workers Compensation Attorney as soon as possible.
  10. There are a number of deadlines in workers compensation cases and the injured worker must ensure to file a claim with the Maryland workers compensation commission within two years from the date of the work accident- the sooner the better.  The longer an injured worker waits to file the claim for, the greater the chances are they will receive a denial.

For a FREE consult from Maryland Workers Compensation Attorney Andrew M. Rodabaugh Call  +1 (410) 937-1659     OR         Email