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If you are injured while working, you can file a workers’ compensation claim with your employer's insurance. However, some applications for these benefits may be denied, and you’ll need to work with a personal injury attorney to appeal the decision. If you’re hoping to avoid common pitfalls and increase your chances of a successful claim, below are several potential reasons for a denial.

Why Are Workers’ Compensation Claims Denied?

1. Improper Notification

After you are hurt, tell your employer about the accident and corresponding injuries immediately. This ensures you can link the injuries to the at-work accident, which is necessary to receive compensation. While you should tell them within a few hours of the injury, you have up to 30 days to do this and file a claim. If you wait too long, their workers' compensation provider will deny the claim. The exception to this is if you develop a disease over a long period that doesn't show up immediately. This is harder to prove, so a personal injury attorney may need to investigate the situation to prove that the condition stemmed from your work responsibilities.

2. Occurred Outside of Work

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When you are seeking funds for your injury, you must prove that it happened during the course and scope of your employment. For example, if you say that you were injured while delivering supplies to a customer, and your employer responds that there were no scheduled deliveries for that day, the insurance provider may deny the claim. Alternatively, if you slipped and fell in a grocery store after work but claimed that your injuries were caused by a fall at work, you will need security footage or witnesses to support this statement and receive approval.

3. Shared Responsibility

Workers’ compensation benefits are reserved for employees who experience injuries while doing their jobs as they were hired to do them. Therefore, if your employer has evidence that you were acting inappropriately, playing a practical joke, or under the influence of drugs or alcohol when the accident occurred, the insurance provider will deny the claim. In these situations, your own actions created the environment that led to the injury, so your employer is not responsible for the damages.

 

If you need a personal injury attorney to help you appeal a claim denial, contact Schoch & Schoch in High Point, NC. This firm has over 80 years of experience helping injured employees fight for the compensation they deserve. They pay attention to every detail to ensure you comply with all related deadlines and guidelines. Visit them online for more information about their services. Call (336) 884-4151 to schedule a free initial consultation.

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