Why Was My Virginia Workers’ Compensation Claim Denied?

red grunge rubber stamp with words CLAIM DENIED

Why Was My Virginia Workers’ Compensation Claim Denied?

If your Virginia workers’ compensation claim was denied, you may be left wondering what went wrong and whether there is anything you can do. Insurance companies are looking for reasons to deny your claim and will cite a multitude of reasons for denying a seemingly valid claim. Fortunately, there are things you can do as the injured party to reduce the chances that your claim will be denied in the first place. If you are interested in understanding why your Virginia workers’ compensation claim was denied, then you have come to the right place. Arm yourself with knowledge and then reach out to our skilled attorneys to learn more about your options.  

Missed Deadlines

The workers’ compensation process is very deadline driven and missing any of the multiple deadlines can result in denial of your claim. In Virginia, an injured employee must provide notice to their employer of a work accident within 30 days (unless your employer is a statutory employer, then notice must be given at least 60 days prior to a workers’ comp trial). This reporting requirement serves two purposes. First, it puts the employer on notice to investigate the accident. Second, notifying your employer of the accident works in your favor to negate any arguments by the insurer or employer that your injuries did not take at work but, rather, were the result of an accident outside of the workplace. 

In Virginia, employees seeking workers’ compensation benefits must file a claim with the Virginia Workers’ Compensation Commission within two years of the date of the accident. If an employee fails to meet this deadline, their claim will be denied barring a few limited exceptions. 

The simple fact is that whether or not you meet the required deadlines is generally within your control. Help yourself, and your case, by being conscious of these deadlines at all times. 

Disputes As To Cause of Injury

Workers’ comp claims are commonly denied based on disputes concerning the cause of an employee’s injury. An insurer may dispute your version of events or allege that your medical records do not support your claim. A discrepancy between the accident report and medical records may also be the blame. This underscores the importance of reporting your accident and receiving medical treatment as soon as possible.

Keep in mind that if your injury did not happen at work, then you are not eligible for workers’ compensation. However, if you were injured while offsite completing a work assignment, at a training, or other work function you may be entitled to benefits.

No Witnesses to the Accident

It is not uncommon for workplace accidents to occur when no other employees are around, but some insurers may use this fact to deny a claim. The best way to avoid this issue is to notify your employer as soon as practically possible and to notify other coworkers of your accident. 

Failure to Seek Medical Care or Care From Approved Provider

To qualify for workers’ compensation benefits, an injured employee is required to seek medical care using a provider from the list of approved treating providers supplied by the employer and insurance company. Failing to use one of the treating providers will serve as a basis for denying your claim. 

Claims may also be denied if an employee fails to seek medical care at all. Remember that you will need medical records to demonstrate that you sustained an injury and that the injury was caused by the work-related accident. Successfully obtaining workers’ comp benefits without medical records is extremely difficult and rare. 

Claims may also be denied if there is a significant delay in seeking medical treatment and an insurer is likely to argue that the injury was the result of other causes, not a work accident.

Presence of Drugs or Alcohol

Your employer may request a drug or alcohol test when you seek medical treatment. If you were under the influence of drugs or alcohol at the time of the accident, an insurance company will deny your claim. While your employer and its insurance company must still prove that the drugs or alcohol were partly to blame for the accident, this can be a tough battle to fight. 

Filing Claim After Termination or Reprimand

Filing a claim for benefits after you have been terminated or after a recent reprimand may raise red flags with the insurance company and cause them to more closely scrutinize your claim. The insurer may deny the claim and argue that the claim was filed out of spite or revenge.

Refusing Insurer Requests for Written Statement or Medical Record Authorization 

An insurance company has the right to review medical records related to your injury claim and medical history, and may request that you complete forms or provide written or verbal statements. They may also ask that you sign a blanket authorization to release your medical records. Cooperation with your employer and its insurance company is necessary to process your claim, but you should consult with an experienced Virginia workers’ compensation attorney before making any statements or signing documents. Cooperation is essential, but you also need to protect your interests and avoid any traps by the insurer, who is looking to avoid liability.  

Preexisting Injury 

If you have a preexisting injury and suffer a workplace accident you are entitled to workers’ comp benefits. However, if your preexisting injury was not aggravated, exacerbated or accelerated by a workplace injury then your claim for benefits may be denied. If you have questions regarding the impact of a preexisting injury on workers’ compensation benefits, check out this article. 

What To Do If Your Virginia Workers’ Compensation Claim Was Denied

If an insurance company has denied your claim for Virginia’s workers’ compensation benefits, you have options and may be able to appeal the decision. At Renfro & Renfro, our Virginia workers’ compensation attorneys have experience handling both sides of workers’ compensation claims. If your workers’ comp claim has been denied, our lawyers will use their unique industry insight to work with you to evaluate your case and help you to obtain the best possible outcome. Contact Renfro & Renfro today for a free consultation.

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