A briefcase icon

free case review

All of our consultations are 100% FREE & confidential.

5 Reasons Why Your Employer Could Deny Your Workers Compensation Claim

A workplace injury can put you out of work for several weeks or several months. During this period, you stop bringing in paychecks, while accumulating medical care bills. This is exactly why Texas legislators created the workers’ comp system. You file a workers’ compensation claim and your employer pays your medical treatments and replacement wages.

As any Houston workers’ compensation attorney can tell you, this is an ideal situation that rarely runs smoothly from start to finish. The fact is that you will not be dealing exclusively with your employer, but also with their insurance company. And one thing is clear about insurers – they don’t want to pay benefits if they can avoid it.

For this reason, your best option is to bring your case to an experienced Houston workers’ compensation attorney as soon as possible after your accident. Otherwise, you risk making mistakes that may get your workers’ compensation claim denied

Texas Workers’ Compensation Rules You Must Follow

In most cases, workers comp claims are denied because you waited too long to report your accident. You may already know that you have one year to fill in and submit the official form to the Texas Division of Workers’ Compensation.

However, workers comp rules state that you must report your workplace accident to your employer within 30 days. You must be able to prove that you sent the notification. Thus, after the initial verbal notification, follow it up with one in writing – either by email or registered letter.

Also, you must accept an independent medical examination by a doctor appointed by your employer’s insurance company. This is almost always the case after filing a workers’ compensation claim, especially if it proves to be very expensive.

Reasons Why an Employer Would Deny Your Workers’ Compensation Claim

In some cases, you may have failed to follow one of the rules explained above. In other situations, your employer may have suspicions that your claim is not genuine.

A Houston workers’ compensation attorney knows that these are the most common reasons why your workers’ comp would be denied.

1. You Waited Several Days Before Notifying Your Employer

Some workers will wait a few days or even up to a week before they notify their employer of a workplace injury. Most of them believe that the pain will go away by itself, and they don’t need to file a claim.

However, your employer will see the situation otherwise. They may suspect that you were under the influence of alcohol or drugs when the accident happened. Thus, you waited until you were certain these substances won’t show up on the alcohol and drug test.

In this situation, it is difficult for a Houston workers’ compensation attorney to argue otherwise. There is simply no evidence to indicate that you were completely sober when the accident happened.

2. You Delayed Seeking Medical Attention

You should not wait until the end of your shift or until the next day to go to the ER for an initial medical evaluation. Some injuries, especially to the head and to the back, can have severe consequences if left untreated.

Also, if you delay seeking medical attention, your workers’ compensation claim is likely to be denied. Your employer may claim that you were actually injured while off duty. Thus, they do not have any obligation to pay for your medical care costs and provide you with replacement wages.

As your Houston workers’ compensation attorney will tell you, even a few minutes can make the difference between a valid and an invalid claim. For instance, an injury you suffered during your lunch break is not covered by workers comp.

any delay in reporting a workplace injury appears suspicious

3. There Were No Witnesses to Your Accident

Employers tend to become suspicious when you cannot produce a single witness to your workplace injury. Today’s workplaces are collaborative spaces – both indoors and outdoors. Theoretically, you should have a few colleagues around you at all times.

Yet, it is quite possible to suffer an accident while (and especially because) you were working on your own, without your colleagues’ assistance. In this case, your attorney will look for any CCTV cameras in the area which should have recorded your accident.

Even with no such evidence available, the medical examination should clarify the likely cause of your injuries and how recent they are. This is yet another reason why you should see a doctor as soon as possible after your accident.

4.  You Failed to Disclose a Pre-Existing Injury

When you go to the mandatory independent medical examination, you should be honest with the doctor. One of the things they will ask you is your medical history. This includes any chronic health conditions and previous injuries.

You should not hide any of them, because the doctor will eventually discover them. And – guess what? Your employer will claim that you are suffering from the symptoms of that old injury and are trying to get a paid vacation.

5. You Downplayed Your Injury Initially

During the first moment after your accident, you may have tried to man up and say that it was not a big deal. So, you report it to your employer as a minor injury. But it turns out that it is more serious than you thought.

However, when you file your workers’ compensation claim, your employer is likely to refer to the initial report as a reason to deny it. For this reason, you should never downplay workplace injuries. Of course, you should not exaggerate them, either.

The best policy is to describe what happened and then let the medical reports detail the nature and extent of your injuries.

Let an Experienced Lawyer Help You File Your Workers’ Compensation Claim Successfully!

We are an experienced law firm, dedicated to helping all injured workers obtain their workers’ comp benefits. We know that insurance companies will try to find any reason to deny your workers’ compensation claim. And we know how to fight their arguments.

However, you must also follow the rules and avoid making mistakes while your claim is under evaluation. The best decision you can make is to schedule a free case review with an experienced workers’ compensation lawyer in Houston as soon as possible after your accident. Call us today at 346-22-1821!

get started on your claim

let our Houston law firm injury lawyers focus on fighting insurance company so that you can focus on getting better.