5 Most Common Reasons Workers’ Compensation Claims Are Denied

5 Most Common Reasons Workers’ Compensation Claims Are Denied

Workers’ compensation is a no-fault insurance that an employer is required to carry under the law. In Alabama, any employer with five or more employees, even part-time workers, must carry workers’ compensation. 

The compensation is designed to be there if you are injured on the job, no matter who is at fault. In exchange, you are barred from filing a personal injury claim against the employer. That is the trade-off.

You are entitled to receive compensation so you can treat your injury by visiting a doctor, receiving therapy, undergoing medical tests, obtaining prescription drugs, prostheses, and lost wages.

If your doctor says you cannot work, you are entitled to receive two-thirds of your regular wages. A severe injury may mean you can collect up to 80% of your wages for up to six months.

Whether a construction site, an office, a hospital, even a library, anywhere someone might be injured, workers’ comp is there for you. At least that is the theory.

In reality, in many cases, your workers’ compensation claim will be denied the first time. 


The assumption is that many people are trying to get something for nothing and may not really be injured. As a result, receiving compensation may not be easy at a time when you really need the system to work for you.

That is why most people seek the assistance of a personal injury law firm when dealing with workers’ comp.

Why Your Case is Denied

In order to access benefits, you must have followed certain procedures.

The Alabama Workers’ Compensation Division handles workers comp cases in the state. The Alabama Department of Industrial Relations can hear and decide any dispute about medical benefits.

If there is a denial, Alabama has no administrative court to hear a workers’ dispute. That means an injured person must file a lawsuit if he needs to contest the denial of a claim.

Make sure you do not miss the two-year statute of limitations within which to file a claim.

All of this raises the hoop through which you must jump. That’s why it’s very important to make sure your claim is as solid as possible.

  • Timely – Did you report your injury to your employer or a supervisor immediately, preferably within five days of the accident? If you failed to do so immediately, it could be assumed that you are not really injured and any questions raised go immediately to your credibility. Honesty is always the best policy.
  • Evidence – Is there medical evidence of an injury? Are there pictures or a witnesses?  Can you describe exactly what happened rather than to just say, “I fell”? Are there any major preexisting conditions that may have led to your injury, such as arthritis or something that may show up in your medical tests? If so, a major contributing cause may not lead to benefits.
  • Where – Did it happen at work? One major reason a claim may be denied is if there is some question as to where the injury happened.  Do you have evidence it occurred on the job? The majority of evidence has to support the claim that it happened at work, not the weekend before outside of work and now you are seeking coverage from your employer.
  • A Statement – Be careful when you recount the accident. A misstatement can damage your case, so make sure you have records and any pictures of the accident or the day it occurred. Was the weather terrible, did a co-worker fail to do his job and leave the workplace in a dangerous condition? Can you prove it?
  • Your Doctor – As long as your doctor says the work accident is the major contributing cause for why treatment is needed, your claim should be okay. On the other hand, if you went jogging last week and posted pictures on Facebook, expect that the other side’s attorney will see that and deny your claim.

Obtain Skilled Legal Counsel

The Mike Bell Firm has extensive experience in the area of Alabama Workers’ Compensation law. We understand the importance of filing a claim and receiving your benefits as fast as possible during this difficult time. We understand how to go up against a reluctant judge and insurance company for the other side.

Please call (205) 666-6000 for a free consultation. You may also message us online or visit our Birmingham office in person at your convenience.

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