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Four Reasons Why a Workers’ Comp Claim Might be Denied

Having a workers’ compensation claim denied can be a shocking and frustrating experience. For many working people, workers’ comp is the best or only available resource for getting care for an injury or illness that happened on the job. When someone can’t keep working or needs long-term care, denied coverage can have profound personal consequences. Here are some of the common reasons why an insurer will deny a claim.
  • The injury or illness is not eligible for benefits.
To be eligible for workers’ compensation coverage, an individual must have been injured or contracted a disease in the course and scope of employment. Workers’ comp is a no-fault form of insurance, which means that an insurer cannot base decisions about whether to approve a claim on the degree to which the employee or someone else is responsible for the injury or disease. But insurers do look closely at the circumstances of the claim to verify that the individual who makes it was in fact working at the time of the injury. Cases involving denied claims have included employees who are injured while commuting, on a lunch break, or between shifts. But the dividing line between work and not-work is not always clear, and sometimes a dispute can arise when, for example, an employee is injured on the way to an employer-provided break room.
  • Missed deadlines and incomplete paperwork.
The insurance adjusters who evaluate the merits of claims are paid to review every detail for breaches of legal requirements. When claim paperwork is submitted late, or required pieces are missing, an insurer may have an excuse for denying an otherwise valid claim. For example, an accident at work needs to be reported to the employer within seven days.
  • Suspicious discrepancies.
Insurers are passionate about guarding against fraud. If they think that a claim is based on misinformation, they will be quick to deny it. Workers can find themselves facing a denied claim if information they provide in their paperwork doesn’t match third-party records, such as those provided by the employer or the physician who conducts the initial evaluation. Injured workers are also getting into trouble by posting contradictory information to social media accounts.
  • Evidence of drugs or alcohol use.
A workers’ compensation insurer can deny an employee’s claims if it finds evidence that the employee was drunk or under the influence of a controlled substance at the time of the workplace injury. This includes recreational marijuana use. An employee can only overcome the denial of a claim on the basis of drugs or alcohol use by showing through clear and convincing evidence that the substance was not a factor in the employee’s injury. Although the facts of an injury may support the employee’s argument, the process will be significantly more complicated as a consequence of drug or alcohol use at work. For over 45 years the law firm of Greenman Goldberg Raby Martinez has represented Las Vegas clients in workers’ compensation claims disputes. We can help you resolve your questions about workers’ compensation coverage and fight back against an insurer that refuses to give you the coverage you deserve. Call us today for a free attorney consultation at 702-388-4476 or send us a request through our site.

Leading Las Vegas Worker’s Comp Attorneys You CAN Afford

Leading Las Vegas Worker’s Comp Attorneys You CAN Afford Being injured while on the job can be both a physically and emotionally draining process. Dealing with the physical pain as a result from an accident can be debilitating and frustrating—especially if it interferes with how you perform at work. However, what do you do when you realize that the worker’s compensation coverage you counted on is either lacking or completely unavailable? Medical bills are expensive and many people don’t budget for the onslaught of expense, making a solid Las Vegas worker’s comp plan imperative. Instead of going deeply into debt to cover expenses for an injury you experienced at work, contact a Las Vegas worker’s compensation attorney. One of the common misconceptions about retaining a worker’s comp attorney is the expense. Injured employees feel that they are already over their head with medical bills and are worried that filing a claim with the assistance of an attorney will only add to their financial stress. While a valid concern, consider if you can afford not to file a claim. When worker’s compensation coverage falls short, employees may not understand that they can pursue a claim for full coverage and CAN afford an attorney. If you have been the victim of a workplace injury in Las Vegas, Nevada, consider the following:
  • Was your injury due to improperly maintained equipment or workplace environment (such as slippery floors)?
  • Did your employer encourage you to continue working even after you experienced an injury?
  • Are you having difficulty paying medical and living expenses after your injury?
  • Have you been terminated as a result of your injury?
Nevada worker’s compensation law is in place to ensure that employees cannot be terminated due to an injury. However, if you voluntarily quit your job while you are on disability leave, you must assume all remaining medical and living expenses. Las Vegas Worker’s Comp Attorneys will help you through your injury, and you will not pay until a recovery is made. It can cost you more in the long run by not pursuing a las vegas worker’s comp case. Under the worker’s compensation system you are automatically entitled to:
  • Continuous medical treatment for the injury that you experienced at work (including surgery, pain management and therapy)
  • 2/3 of your gross wages up to the statutory minimum
  • Evaluation for permanent impairment or disability
  • If unable to return to your former position, you are eligible for retraining or school
If you are missing out on these benefits, you absorb these costs, which can be financially devastating. Immediately following an injury at work, Las Vegas worker’s comp attorneys urge clients to schedule an initial free consultation with an attorney to establish a case and pursue the compensation they deserve. For more information about Las Vegas worker’s comp legal fees, contact Greenman, Goldberg, Raby, Martinez Law Firm today at 702-388-GGRM (4476) and allow us to review your case.  We are also bi-lingual--hablamos Espanol!