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Has the insurer denied your workers' comp claim?

One careless move or moment of distraction can result in a work injury. Injuries on the job also occur if equipment is defective or workers do not receive appropriate training. You may also suffer an illness or medical condition due to repetitive motions or exposure to toxic substances.

No matter how you became ill or injured on the job, you may have felt a sense of relief when you remembered Michigan's law requiring certain employers to carry workers' compensation insurance. This insurance provides benefits to cover your health care and lost wages no matter who is to blame for your injury. However, you may be surprised to learn that the insurer providing workers' comp at your workplace can deny you coverage in certain circumstances.

Why was my claim denied?

Receiving a letter from the insurer explaining that they have denied you coverage for your work-related injury can be a devastating blow. You may have lost weeks of wages by this time, and your medical bills may be taking a significant bite out of your family budget. You can always appeal the decision, but first it may help to understand some of the valid reasons why an insurer may deny workers' compensation benefits, including these:

  • You did not report your injury to your employer in a timely manner.
  • Your employer failed to file your claim with the insurer.
  • Your injury is not covered by workers' compensation, such as those you suffer on your commute to work or during a recreational activity like a company picnic.
  • Your employer disputes your claim that your injury is work related.
  • You did not provide enough evidence to support your claim that your injury is related to your duties at work.
  • You did not seek medical treatment, comply with doctor's orders or supply documentation of your medical care for your injuries.

The insurer will likely deny your claim for workers' compensation if your injury occurred while you were impaired by drugs or alcohol, or if you suffered injuries during horseplay or fighting on the job. If your employer can demonstrate that your injury resulted from your willful refusal to follow strict safety protocol, the insurer may deny your application for benefits.

If none of these exceptions apply to you and the insurer still denied your claim, you may wonder what your next step should be. Many in Wisconsin find relief with the advocacy of an attorney who has a history of success protecting the rights of injured workers.

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Adler Firm, PLLC