Oklahoma’s workers’ compensation system exists to help employees when they sustain injuries or illnesses on the job. The goal is to compensate employees for their losses when they get hurt performing tasks they’re required to do as part of their work duties.
Unfortunately, there are many instances where insurance companies deny legitimate claims. The system is complex and claims can be turned down for any number of reasons.
What you may not know is that if your claim is denied, you have the right to appeal this decision. But why was your claim denied in the first place?
The following are the most common reasons why your workers’ comp claim was denied:
- You failed to notify your employer in a timely manner. To be eligible for workers’ compensation in Oklahoma, the injured person must report the injury to their employer within 30 days. Repetitive use injuries and occupational illnesses must be reported in writing within six months of developing obvious symptoms of the disease or condition, or within 30 days of leaving your employment—whichever occurs first. If you fail to meet these deadlines, you may lose some or all of your benefits.
- You failed to receive medical treatment. If you believe your injury is entitled to a claim, you will need the medical records to prove it. If you fail to obtain medical care, but later try to file a worker’s comp claim, without the supporting medical evidence, the insurance company can reject your claim on the basis that you faked your injury. Make sure you visit a doctor to help file a successful claim.
- Your employer disputes the version of events. Your employer might claim that the accident didn’t occur in the way that you claim it did. They might say that there are discrepancies to your story and attempt to blame your injuries on a pre-existing condition or claim that your accident happened outside the scope of your employment. Your best bet to back up your claim with witness testimony or with the opinion of a medical professional who can verify that your injuries are consistent with your version of events.
- You did something to contribute to your injury. If you did certain things to contribute to your accident, you do not have a right to collect workers’ compensation payments. For instance, if you were intoxicated at the time of your accident, the insurance company might refuse to pay since your drunken state may have prevented you from avoiding the accident. Similarly, injuries caused by practical jokes or horseplay are typically not covered, unless the employer about and tolerated this type of behavior on the job.
Keep in mind, workers’ comp insurers often deny claims to keep their own costs down and maximize profit. If you think your claim was denied wrongfully, you may appeal the decision to Oklahoma’s workers’ compensation agency.
For more information, contact our Oklahoma City workers’ comp attorney at the Law Offices of Dan Davis today.