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Why Was My CT Workers' Compensation Claim Denied?

Why Was My CT Workers' Compensation Claim Denied?

In the event of suffering an injury while performing job duties, Connecticut employees can recover workers’ compensation benefits to pay for medical expenses, lost income, disability, and even vocational training. Having these benefits help workers recover from injury, help them transition into another role in the company or another job entirely, or provide compensation for the rest of their lives.

Unfortunately, employers and insurance companies are only interested in protecting their own best interests rather than using company expenses to pay for your workplace injuries. It is not uncommon for them to deny workers’ comp benefits for injured employees--no matter how legitimate the claims actually are.

Common reasons why workers’ comp claims are denied include:

  1. You failed to report the injury immediately - As soon as the injury occurs, you must report the incident to your employer, manager, or supervisor as soon as possible. The “Employer’s First Report of Occupational Injury or Illness”’ must be completed and a copy needs to be sent to your employer within seven days. In the eyes of your employer and its insurance provider, failure to report your injury on time could mean your injury wasn’t serious.
  2. You didn’t seek immediate medical attention - Sometimes workers who suffer injuries attempt to “wait it out,” believing time will heal their wounds. However, they could discover that their injury is more serious as originally thought and end up visiting a doctor days or even weeks after the accident happened. If you failed to receive immediate medical treatment, you won’t have the supporting medical records to prove your claim. If you failed to obtain medical care in a timely manner, the insurance company could say your injuries weren’t as serious as you originally claimed.
  3. Your employer disputes your claim - Your employer may claim that you weren’t working when you were injured. For example, if you suffered an injury during your commute either to or from work, your break, or your lunch, you are not eligible for workers’ compensation since the accident occurred when you are not performing work duties.
  4. You were involved in misconduct - Whether you were under the influence of alcohol or drugs or your injury was the result of pranking or horseplay, your injury will not be covered if some form of misconduct was involved.
  5. Your injury is from a pre-existing condition - If you suffered an injury or illness prior to working for your current employer and your job duties did not worsen the injury, it won’t be covered by workers’ compensation benefits.

Just because your workers’ compensation claim was initially denied doesn’t mean you can still try to obtain benefits. The denial letter typically includes the main reason why your claim was rejected. If it’s due to a paperwork error, contact the claims adjuster to determine if you can resolve the issue. But if it’s something more, you need to hire an experienced workers’ comp attorney to help you file an appeal.

For more information about workers’ compensation in Connecticut, contact our Waterbury workers’ comp lawyers at Fitzpatrick Mariano Santos Sousa P.C. and schedule a free consultation today.

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