An injured worker, or survivors of a worker who was in a fatal workplace accident, must file a claim for workers’ compensation benefits in accordance with a variety of complex rules and deadlines. Additionally, a claim must contain voluminous information about the worker’s employment history, salary, injury, and medical care received.
Any discrepancy can be used by the employer, the workers’ comp insurance company, or even an overworked claims analyst to deny a claim. Once benefits are approved, they can be discontinued if the beneficiary violates the requirements of the Oklahoma Workers’ Compensation Commission.
Please access the OWCC website for existing claims.
Some common reasons an Oklahoma workers’ comp claim may be denied include:
- Your injury is not covered. There are a few circumstances in which an injured worker will not qualify for benefits, such as:
- Injuries suffered while reporting for a shift or leaving at the end of a shift, or in a parking lot or other area adjacent to the place of business, may not qualify. (It is definitely important to obtain experienced legal advice in cases of this nature.)
- Your injury was caused by your use of drugs or alcohol.
- You were injured while engaging in recreational or social activities, including “horseplay.”
- You were injured while on a work break unless the break was authorized by your supervisor and the injury occurred inside your employer’s facility. (Again, it is definitely important to obtain experienced legal advice in cases of this nature.)
- The injury was caused by pre-existing condition(s), unless you can show a pre-existing condition has been significantly aggravated in the course and scope of your employment.
- You failed to provide your employer with timely notification of your injury. You must provide notice within 30 days of the injury, or within 30 days after separation from employment for a cumulative trauma injury (e.g., chronic lower back pain or carpal tunnel syndrome). It is best to report an injury and subsequent medical care in writing as soon as possible. However, again there are exceptions to this general rule, so in cases of this nature, it is extremely important to speak with an experienced workers’ compensation attorney.
- You have no witnesses. If no one but you knew about the accident that left you injured so badly you need medical attention, this raises a red flag with many workers’ compensation insurers. If you have no direct witnesses, tell a supervisor or other responsible co-worker as soon as possible about your accident and injury. The fact that there were no witnesses can sometimes make a case more difficult but it does not mean that you cannot collect benefits.
- You filed for benefits after being fired or laid off. Insurers will be suspicious of a claim filed by an employee who has been terminated. They will suspect it is more about revenge than a valid medical need. This is an additional reason to report an accident or injury to a supervisor promptly and to notify your employer of obtaining medical care for it as soon as possible.
- There are discrepancies in your claim documents. For example, if the way you initially described your accident and injury to your employer is not reflected in initial medical reports, this could be a problem.
- You don’t provide evidence of an injury. Your benefits application must “prove by a preponderance of the evidence” that your injury keeps you from working and that your injury occurred in the course of employment and arose out of your employment. An experienced workers’ compensation attorney can explain the evidentiary requirements in a claim.
- You have not followed doctors’ orders. Failing to abide by the restrictions and treatment plan given to you by your treating physician, including attending all doctors’ appointments, can be interpreted as an indication you are not as badly injured as you claim. Your claim is likely to be denied, or existing benefits can be terminated. You must also keep any scheduled appointments with the insurer and job counselor.
Our Oklahoma City workers’ compensation lawyers at Ryan Bisher Ryan & Simons can help you avoid mistakes or combat denial of a workers’ comp claim. Contact us today to schedule a free consultation on your options for moving forward.
