Denied Workers’ Comp Claims: Reasons and How to Appeal in Colorado

A denied claim can come as an extremely unwelcome surprise for injured workers in Colorado. However, it does not necessarily end your pursuit of compensation. The first step is to determine the cause of your denied claim. Once you understand why your claim was denied, you can strive for positive results. Another important initial step is to contact an experienced workers’ compensation lawyer in Colorado. These legal professionals can investigate your situation in more detail and determine the most appropriate course of action.

• The Pre-Existing Condition Defense

One of the most common reasons for a denied claim is an alleged pre-existing condition. The insurer may attempt to argue that your workplace injury is pre-existing. For example, you might have suffered a broken ankle while playing sports outside of work hours. If you attempt to file a workers’ comp claim for this injury, the insurer would be justified in sending you a denial letter.

The problem is that many pre-existing injuries are eligible for workers’ compensation. If your pre-existing condition was aggravated or worsened by workplace duties, you can still file a claim. Colorado accepts that pre-existing injuries can be aggravated by work activities. As a result, a claim should cover your medical expenses and missing wages if you lose the ability to work. For example, your pre-existing arthritis might be worsened by repetitive motions at work – eventually leading to total disability. Your workers’ compensation lawyer can help you establish a causational link between your job and the degradation of your pre-existing conditions. This can form the basis of a successful appeal.

• Claims of Intoxication

Intoxicated workers may still receive work compensation benefits. After a work-related accident, your employer might force you to take a drug/alcohol test. If you test positive for intoxicating substances, your medical benefits remain available, but your wage and permanent impairment benefits may be reduced by 50%. However, this is not necessarily the end of your claims process. After a denial letter based on alleged intoxication at work, you should consider your legal options alongside a workers’ comp attorney. The attorney may be able to get the test result stricken if a second sample is not available for a re-test.

• Your Accident Did Not Occur at Work

Insurers and employers may also attempt to deny your claim if the accident was not work-related. For example, you might have crashed your car while driving to a nearby restaurant during lunch break. While this is a clear example of an accident that is not work-related, other cases may not be so clear-cut. What happens if you stumble and fall in the parking lot while walking away from the office? In these situations, your workers’ comp attorney can help you prove that your injuries are work-related.

• No Medical Records

After a work injury, it is very important to seek medical assistance as soon as possible. If you fail to get treatment, your claim may be denied. This is because insurers examine your medical records to determine the legitimacy of your injuries. If you never get treatment, there will be no record of your injuries. Even if the cost of treatment seems daunting, it is best to see a doctor. Your workers’ comp claim should cover your medical bills anyway. Even unnecessary delays before seeing a doctor can cause insurers to doubt the legitimacy of your injuries.

• Horseplay

Workers may also struggle to get compensation for their injuries if their accident was caused by horseplay. The definition of “horseplay” is somewhat vague, but it may include pranks, jokes, and games during working hours. A workers’ compensation attorney can help you establish that your injury was not caused by horseplay.

Contact The Law Offices W. Dan Mahoney, P.C.

If you are ready to approach your denied claim with confidence, book a consultation with The Law Offices of W. Dan Mahoney, P.C. During an initial consultation, we can discuss why your claim might have been denied. After we determine the cause of your denial, we can respond in the most appropriate manner. Rest assured that a denied claim is not necessarily the end of your journey toward financial security after a workplace injury in Colorado. With our help, you can take decisive action and fight for your rights as a worker.

Category:

• Personal Injury
• Wrokers' Compensation