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Missouri Sunset

What causes my workers’ compensation benefits claim to be denied?

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Posted on September 19, 2017

As an injured worker in the St. Louis area, one concern that may be on your mind is your whether your workers’ compensation benefits claim will be denied. You have been off work for a few weeks now and are starting to feel the stress and frustrations that many hurt workers feel experience when their income is reduced or comes to a sudden halt because they are unable to work. 

You may already be aware you are eligible to receive workers’ compensation medical and disability benefits from your employer. However, not every claim is approved. Take some time to learn about some factors that can lead to the reduction or denial of your workers’ compensation benefits. 

Time limit to file a report and claim 

Claims for workers’ compensation benefits must be filed within a certain time limit. You must also inform your employer about any incident that happens at your job or while you are performing work-sanctioned duties offsite that lead to your injury. Every workplace accident does not qualify. For example, if you were on a nonprescription controlled substance or engaging in behavior that goes against company policy, your employer has the right to deny your claim. 

Lack of documentation or proof 

It is possible for you to suffer a serious injury and feel fine a few days later. You could even receive ongoing medical treatment for your injuries but think you do not need them because you cannot afford them or do not want them. A valid workers’ compensation claim must have sufficient evidence to support it. Going to work-approved doctors and following through with all recommended treatment help prove your injuries do exist and are as serious as you claim. Your doctors and care providers must document their observations about your injuries, diagnosis, treatments and any symptoms and issues you share with them regarding your work-related injuries. 

Difficult to prove injuries 

Not all workplace accidents cause open wounds, bleeding or other obvious symptoms. For example, you could have a repetitive stress injury, post-traumatic stress disorder or some other hidden ailment your employer does not believe you have. It can be hard to prove those kinds of injuries occurred on the job or during the course of your employment from work-related duties. 

Employer does not want to pay 

Employers do not always examine the facts or carefully review incident reports and other critical facts before making decisions about workers’ compensation claims. Sometimes, they deny them because they do not want to accept any responsibility and are trying to keep their workers’ compensation insurance premiums under control. 

If your claim ends up getting denied, you do have the right to appeal the decision. Deadlines for appeal are very strict, and any misstep during the appeal process can lead to you not receiving a portion or all of your benefits. You may benefit from speaking with an attorney about your situation for guidance.