Under Tennessee workers’ compensation laws, most companies with more than 5 employees are required to purchase insurance to cover their workers’ injuries. With a few notable exceptions, almost any injury that you sustain because of your job can make you eligible for insurance coverage, as long as you follow the guidelines and meet all state requirements.
However, while your employer can’t outright deny your workers’ compensation benefits, theycan make it difficult to get the compensation you need for medical treatments and expenses. At Donati Law, PLLC, our skilled lawyers are committed to helping our clients move past workers’ compensation denials, so that they can begin the healing process and move forward.
If your workers’ compensation claim has been denied, contact our Memphis workers’ comp attorneys at (901) 209-5500. We can help you understand why the denial happened, and search for a better solution.
Why Was My Workers’ Comp Claim Denied?
Many people mistakenly assume that workers’ compensation is a nearly automatic process, and that most claims are easily and quickly approved. Unfortunately, worker’s comp claim denials happen all the time, for a wide range of reasons. In fact, the Office of Workers’ Compensation Programs (OWCP) reports that most Tennessee claims are denied.
Additionally, although most states follow a strict “no fault” system for workers’ compensation, Tennessee law requires that work activities must be more than 50 percent of the cause of the injury or need for treatment. For example, if you were engaged in any horseplay at the time of your workplace accident, that alone could cause the insurance adjuster to say that your claim isn’t compensable.
Here are a few of the most common reasons an insurance adjuster might deny your workers’ comp claim:
- The injury wasn’t reported to your employer within 30 days.
- The claim wasn’t filed with the Department of Labor and Workforce Development within the one-year timeframe.
- You were injured during a recreational activity, such as a paid company outing.
- Your injury was due to self-harm, or because you refused to use safety gear.
- You never sought medical treatment, or didn’t use a medical provider authorized by your employer.
- You were intoxicated, high, or using illegal substances before the accident.
What Happens If My Employer Contests the Claim?
Although your employer is obligated to report your claim within one day of learning about your injury, they don’t necessarily have to agree with you on the specific details of that claim. Depending on your unique circumstances, your employer may argue that your injury actually happened off the clock – or that you failed to meet workers’ comp eligibility requirements, for any of the reasons listed in the section above.
Because filing a claim prevents you from suing your employer, your best option may be to hire a workers’ compensation lawyer, especially one familiar with the laws in your state. The employer’s insurance company is far more likely to take the word of your employer while assessing your claim, and although they may assign a neutral mediation specialist to resolve any disputes, it may not be enough to change your employer’s mind.
Can I Appeal the Claim Denial?
Whether your claim has already been denied, or you simply suspect that your employer will try to contest your benefits, you reserve the right to appeal a claim denial within 60 days. At Donati Law, PLLC, our legal team has more than 35 years of experience representing individuals who have been unfairly denied on their workers’ comp claims. We’ll fight on your behalf and help you seek the maximum allowable compensation for your injuries.
Ready to get started? Call us at (901) 209-5500 today for prompt assistance.