Navigating Workers’ Compensation: Understanding Claims and Denied Cases

Employees who sustain injuries while at work are eligible for compensation through the workers’ compensation insurance program. Upon injury, the employee should file a claim after which the insurer commences an investigation to verify the viability of the case. The worker’s compensation claim is categorized into one of two groups

  • Occupational disease
  • Accidental injury

Unfortunately, not all injury cases qualify for compensation under this program. However, if your claim was denied, that does not mean you should give up hope. A work injury attorney Phoenix trusts may be able to refile your claim with additional substantiated information and recover your damages.

Not Issuing Notice to the Employer
Worker’s compensation laws require employees to notify their employers of an injury within a given timeline, usually thirty to ninety days. It is a good rule of thumb to provide notice to the supervisor immediately after the injury occurs or as recommended by a personal injury attorney.

The Statute of Limitations
States have a time limit during which employees must file a workers’ compensation claim after sustaining an injury while on the job. Depending on the state, the statute of limitations is usually anywhere from one to three years after the injury occurs or else the claim will be denied. The statute of limitations tends to be more flexible if victims have suffered a late appearing illness as a result of exposure to toxins. This is because the effects and symptoms may not appear until years after leaving the job.

No Substantial Link to Employment
If an employee suffers a cut at work but fails to attend to it and the cut subsequently escalates to a serious condition, they may not qualify for compensation. If the employee did not make a reasonable effort to provide self care, they will have a difficult time proving that their employer is liable. Here are additional examples of injuries sustained by workers that may not qualify for compensation due to:

  • Negligence or violation of employer’s safety rules
  • Lack of proof of the cause of accident
  • Not attending doctor’s appointments
  • When the injury isn’t as grave as claimed by the worker

Common Injuries that are Valid for Workers’ Compensation Claims

1. Slip and fall injuries
These are the most common types of injuries for workers compensation. They often occur as a result of wet or slick floors, or rough and uneven surfaces in the work area. Injuries such as broken bones, torn ligament, or nerve damage resulting from trip and fall at work are viable for compensation. If you sustained an injury of this type, as much as is practical, photograph and otherwise document the conditions for proof of your claim.

2. Overexertion
Overexertion involves injuries from pushing, pulling, lifting, throwing and carrying activities in the workplace. Under this category, claims for torn ligaments and overstretched joints are very common. However, they are difficult to prove, and their effects are long-lasting. A workers comp attorney with experience in pursuing claims similar to yours may be able to help you receive fair compensation for your injury.

3. Adverse Body Reactions
These injuries result from free body movement like slip without falling, repetitive body motion and staying in unnatural positions among others. Such injuries occur in areas with machinery and tools strewn everywhere, or in limited spaces and unusual sites. They can be hard to prove or follow up step-wise.

Prompt action in reporting an injury and documenting evidence, coupled with good legal representation, are key for successfully receiving workers’ compensation.