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4 common reasons for workers’ compensation claim denials

On Behalf of | Dec 7, 2020 | Workers' Compensation |

While accidents may occur in any industry, some industries are harder on the body than others. According to Minnesota’s Department of Employment and Economic Development, also known as DEED, the state’s top sectors include manufacturing and agriculture, both of which have high injury rates. 

When an employee sustains an injury on the job, the usual course of action is to file a workers’ compensation claim. However, there are cases where employers or insurers deny such claims. This may be due to various reasons. 

1. The worker did not notify appropriate personnel soon enough

There is a 14-day period after a person receives an injury to report it. Workers need to inform employers of any harm as soon as possible. A lengthy stretch of time between the incident in which the employee experienced physical harm and the date of the actual reporting builds suspicions of wrongdoing. 

2. The worker operated while under the influence

Being intoxicated at work usually counts as grounds for claim denial. It constitutes negligent behavior, placing at least partial responsibility on the worker. 

3. The employer fights it

Employers (or insurers) may dispute claims if they believe they are fraudulent. This may be the case if there is legitimate reason to believe the injury is false or actually existed beforehand. 

4. The worker suffered harm during nonwork hours

Workers may face denial if the damage came about outside work hours. Injuries may not count as work ones for people not on the clock, even if they acquire them at their workplace. 

Note that while workers in Minnesota qualify for medical treatment benefits even for minor injuries, only severe injuries entitle them to full benefits. For example, workers with injuries that do not prevent return to work may not receive wage loss or other monetary compensation.