When you get hurt on the job and you file for workers compensation benefits, you expect to receive the benefits you are owed. While this happens for some workers, for others, collecting benefits can be a challenge. If your employer denies your claim, you need to know what to do next. This starts with understanding why your claim was denied.
Employers (and their insurance companies) deny workers compensation claims for a variety of different reasons. Some of these reasons are valid, and some of them are not. If your employer denied your claim for an invalid reason, then you should still be able to collect benefits. If your employer denied your claim for a valid reason, whether you can still collect benefits depends on whether you can fix the issue that caused your denial.
7 Reasons Employers Can Deny Workers Compensation Claims
Here are seven valid reasons why employers can deny their employees’ claims for workers compensation benefits. Some of these issues can be fixed (as long as you address them in time), and some of them cannot:
1. You Waited Too Long to Report Your Injury
Under Wisconsin law, you have 30 days to report your injury or illness to your employer. This 30-day period runs from the date you knew, or “ought to have known” of your condition. For injuries sustained in falls, collisions, and other accidents, this generally means that you must report your injury within 30 days of the accident. For repetitive stress injuries and occupational illnesses, determining when the 30-day reporting period expires can be more complicated.
2. You Waited Too Long to File Your Claim
The deadline to report your injury or illness isn’t the only deadline that applies to your workers compensation claim. If your employer does not pay the benefits you are owed after you report your injury or illness, you then have two years (in most cases) to file a claim with the Wisconsin Department of Workforce Development (DWD). If you don’t file your claim within two years, this can justify your employer in denying your claim for benefits.
3. You Didn’t Provide Enough Information
An injury or illness only qualifies for workers compensation benefits if it occurs within the scope of your employment. In other words, you must have a job-related injury or illness in order to collect workers compensation benefits. If you didn’t provide enough information for your employer to determine whether your injury or illness qualifies, this could be the reason (or one of the reasons) why your employer denied your claim.
4. You Provided False or Misleading Information
Employers can deny claims for workers compensation benefits when employees provide false or misleading information regarding their injuries. This is true even if you provided false or misleading information unintentionally. Intentionally providing false or misleading information is considered workers compensation fraud, and it can provide justification for a permanent denial of benefits.
5. You Didn’t Seek Medical Treatment
When you suffer a job-related injury, seeking medical treatment isn’t just important for your health. It is also important for your workers compensation claim. If you haven’t seen a doctor, your employer isn’t going to pay benefits. If you waited too long to see a doctor, your employer might try to use this as a basis for denying your workers compensation claim as well.
6. Your Medical Records Don’t Indicate that Your Injury is Job-Related
When you see a doctor for treatment, it is important to tell your doctor that you suffered your injury or illness on the job. Your doctor should note this in your medical records. If your medical records don’t indicate that your injury is job-related, this could be why your employer denied your claim.
7. You are Not Eligible to Receive Benefits
Not all workers are eligible to receive workers compensation. If you are not eligible, then you are not entitled to benefits even if you got injured or sick on the job. If you are not eligible to receive workers compensation through your employer, you may have other options available.
3 Reasons Employers Can’t Deny Workers Compensation Benefits
As we mentioned above, in addition to denying workers compensation claims for valid reasons, employers will often deny claims for invalid reasons as well. Some examples of invalid reasons for denying workers compensation claims include:
1. You Have a Pre-Existing Condition
In Wisconsin, employers generally cannot deny workers compensation benefits on the basis of a pre-existing condition. For example, if you had a bad knee and you reinjured your knee at work or your pain got worse from doing your job, you are entitled to benefits under Wisconsin law.
2. You Caused Your Own Injury
Workers compensation is a “no fault” system. This means that you are entitled to collect benefits even if you caused your own injury.
3. Your Employer Wants To Avoid Paying
Finally, your employer cannot deny your claim simply because it wants to avoid paying. Unfortunately, this is all it takes for some companies to deny benefits. If your employer does not have a valid basis for denying your claim, then you should still be able to collect benefits with a lawyer’s help.
What To Do if Your Employer Denies Your Workers Compensation Claim
If your employer has denied your worker’s compensation claim, what should you do? At this point, you will want to speak with workers compensation attorney promptly. An experienced Wisconsin workers’ compensation lawyer will be able to determine why your claim was denied and what (if anything) you can do to collect benefits. If you have a valid claim, your lawyer can then fight to secure the benefits you deserve.
Schedule a Free Consultation with a Wisconsin Workers Compensation Lawyer
Has your employer denied your claim for workers’ compensation benefits? If so, contact us promptly for a free, no-obligation consultation. To speak with a Wisconsin workers compensation lawyer at Mays Law Office in confidence, call 608-257-0440 or tell us how we can reach you online now.