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Why Was My Workers’ Comp Claim Denied?

Why Was My Workers’ Comp Claim Denied?

If you were injured while performing work duties in New Mexico, you are entitled to workers’ compensation benefits while you make the best possible recovery from injury. However, it is possible that your claim is denied—despite the fact you have a legitimate reason.

The truth is that employers and insurance companies must spend money on valid claims. Additionally, the insurance rates employers receive increases. Denying claims saves them money, which means they will look for any way possible to do so.

The following are the most common reasons workers’ compensation claims are denied:

  • Your application was late – You must report your injury to your employer to receive workers’ compensation benefits. While you have 15 days after the date of your injury, you need to let your employer know immediately. Even if you suffered a minor injury, waiting until it is serious enough for medical attention is a mistake. Any delay in filing your claim may draw suspicion from the insurance company, assuming your injury is not as serious as you claim.
  • You failed to receive immediate medical care – Without any medical records to support the legitimacy and seriousness of your injury, the insurance company may claim that your injuries do not exist. Not only can a doctor provide necessary medical records, but also determine the full extent of your injuries and the proper treatment to help you make a full recovery. Ensure you are treated by an approved medical provider.
  • There were no witnesses – Accidents that do not have any witnesses are often questioned by insurance companies. Even if there are no witnesses, you must notify your supervisor or coworkers about the injury right away. Use your cell phone to take pictures to gather evidence for your claim.
  • You have a pre-existing injury – Insurers typically use this reason to deny a workers’ comp claim. They will inform injured workers that they’re not going to provide benefits for an ongoing injury. However, if you have a pre-existing condition and your work duties aggravate or exacerbate the condition, you qualify for workers’ compensation.
  • Your injury wasn’t work-related – If your injury occurred during the course of employment—even if you were on a business trip or running errands for your employer outside normal work hours—you are covered by workers’ compensation. But if you sustained an injury during your commute to or from work, it will not be covered.

If your workers’ compensation claim was denied, you still have an opportunity to obtain benefits. At Michael J. Doyle, Attorney at Law, we can evaluate your case, determine all your legal options, and maximize your entitled benefits to help you heal.

For more information about our legal services, contact us at (505) 219-2176 and schedule a free consultation today.

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