10 Surprising Reasons An Insurance Company Might Deny Your Claim

There are some obvious reasons why an employer and its insurer might deny your workers’ compensation claim; the most obvious being if the employer thinks your injury is not related to your work activities, or if they contend you were intoxicated at the time of your accident.

However, some reasons that insurance companies deny claims might surprise you. Here are some examples of things that raise alarm bells when an insurance company is investigating a workers’ compensation claim, and may even lead them to unjustifiably deny a claim:

1.     You have had a prior workers’ compensation claim;

2.     You were written up or disciplined shortly before reporting your accident;

3.     You had only worked for the employer for a few days or a few weeks before getting injured;

4.     Your accident was reported shortly after a day off or a vacation;

5.     You went to a chiropractor or personal doctor before reporting your injury;

6.     Your documentation to legally work in the U.S. is invalid or expired;

7.     You report an injury or accident close in time to the company conducting layoffs or terminations;

8.     You have a medical history of treatment for the same body part you injured at work;

9.     You misstated or omitted something on your job application;

10.  Your supervisor does not like you or you have had conflicts with co-workers.

Even if any of the above situations apply to your claim, you may still be entitled to workers’ compensation benefits. However, for insurance companies and claims adjusters who are on the lookout for “red flags” and who would prefer to deny claims first and ask questions later, any one of the above situations may be used as a pretext to deny your claim.

If you feel that your claim has been unfairly denied or that the insurance company is conducting an unnecessary investigation of your claim feel free to contact the O’Connell Law Firm today.