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Top Reasons Insurance Companies Deny Workers’ Compensation Claims

Posted by Liz Delsa | Sep 07, 2023 | 0 Comments

When you're injured in a workplace accident, you want to make sure your claim for workers' compensation benefits is accepted and processed by your employer's insurer (or by your employer, if it's self-insured) quickly and fairly. To ensure this happens, it's important to understand some of the main reasons that insurers deny workers' compensation claims.

Delay in Reporting

In Louisiana, you must notify your employer of a workplace-related injury within 30 days of when it happens or when you become aware of it (if the injury isn't immediately obvious). If you delay in reporting your injury until after this period, you give an insurer a reason to deny your claim for benefits.

The Injury Was Not Accidental or Was Not Work-Related

Workers' compensation provides coverage for injuries caused by a workplace accident and injuries caused by exposure to the work environment. The injury must be one “arising out of and in the course and scope of” your job. An “accident” for purposes of Louisiana workers' compensation law means something “unexpected or unforeseen” that happens “suddenly or violently” that produces an injury. The accident causing your injury must happen “out of and in the course of” your employment. This is a frequent issue for workers' compensation claims. If your injury happened when you were on your way to work or on a lunch break, it may not be covered. If it occurred due to horseplay in the workplace, it might not be covered because the insurer may argue that the horseplay was not something you were doing “in the course of” your employment.

Sometimes the questions are more difficult to answer. If you are asked to pick something up for your employer on your way into work – a spare part, or some supplies, for example – and you're injured in an accident, is that a workplace-related accident that entitles you to workers' compensation benefits? The answer depends very much on the facts of the situation and is something that the Delsa Law Firm, LLC, helps clients with regularly.

The Injury is an Illness or Disease Unrelated to Your Job

Another situation where workers' compensation claims may be denied at first is when the employee claims that an illness was work-related. Under Louisiana law, workers' compensation benefits are available where your disease or illness suffered by the employee results from “causes and conditions characteristic of and peculiar to” your job. But these links between an illness and a job can be difficult to prove, especially where they develop over a long period. As a result, insurers may initially deny your claim for workers' compensation benefits, and you may need to provide additional proof before your claim will be accepted.

How the Delsa Law Firm, LLC, Can Help

If you've been injured in a workplace accident or believe you may be suffering from a workplace-related illness, contact the Delsa Law Firm, LLC, for help. We understand Louisiana workers' compensation law and procedures. We can help you meet all applicable deadlines and provide the information the insurer needs to process your claim. Where your claim has been denied, we will help you understand why and will fight for your right to receive benefits if they have been wrongfully denied.

At the Delsa Law Firm, LLC, we help clients from all over Louisiana – including those who live in other states and work in Louisiana – with their Louisiana workers' compensation claims. Our office is located in Slidell, near the intersection of Interstates 12, 10, and 59, so we are easy to get to no matter where you are in the region. Call us today at (985) 882-1222, or schedule a confidential consultation using our online contact form.

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