Why Claims Are Denied According to Workers’ Compensation Law in Twin Falls, ID

When an on-the-job injury occurs, workers’ compensation benefits provide employees with a safety net that helps them make up for lost wages and medical bills. However, getting these benefits is often challenging, and many legitimate claims are denied. Here, clients will learn some of the most common reasons for claim denial.

Failure to Report the Injury Immediately

As outlined in employee handbooks everywhere, an injured worker is required to formally report an injury to the employer within thirty days of the event. According to workers’ compensation law in Twin Falls, ID, a claim can be denied if it’s not reported within that time.

No One Witnessed the Injury

When workplace accidents occur, it’s crucial to get input from witnesses. Failure to name those witnesses may cast doubt on when and how the accident occurred, and a claim denial may result.

Failure to Seek Medical Attention

Workers’ compensation law in Twin Falls, ID requires bosses to post a list of approved doctors for injured employees. A claim might be denied if the worker fails to seek medical care or visits an unapproved provider.

Discrepancies Between Medical Records and the Accident Report

Seeing a physician right away, reporting every symptom, and undergoing recommended testing plays a crucial role in documenting a workplace injury and getting the claim approved.

The Injury Didn’t Happen on the Job

A pre-existing injury that’s not aggravated by a workplace accident or one that happens on the way from or to work isn’t covered by workers’ compensation.

The Presence of Alcohol or Drugs

Right after an accident, a worker may be required to submit to blood testing for drug and alcohol usage. If they’re found to be under the influence of mind-altering substances, the claim may be denied.

Filing an Appeal

If a workers’ compensation claim is denied, the employee will be informed of the reasons behind the decision. Workers have the right to appeal the decision, which they may do by requesting a court hearing within a certain time. During the hearing, a judge will listen to both sides’ stories before making a decision. A worker has the right to hire an attorney at any time during the process, and it’s best to do so early on so the claim is properly represented. Visit us online or call today to schedule a consultation.