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Most Common Reasons an LA Workers’ Comp Claim is Denied

You can find out if your concerns are valid by reviewing the most common reasons why insurance companies deny workers’ compensation claims. If it sounds like one of these reasons applies to your claim, there is a good chance it will be denied.

Fortunately, even if your claim is denied, you may be able to appeal and overturn the insurer’s decision. Simien & Simien’s workers’ compensation lawyers can help you with each step of your appeal.

Your Claim was Filed Late

With few exceptions, workers’ compensation claims must be submitted in writing within 30 days of an on-the-job injury. If you wait more than 30 days, you may forfeit your right to receive compensation for medical bills and other expenses.

That is why our workers’ compensation attorneys advise injured workers to submit claims as soon as possible.

Submitting claims quickly is also important because waiting increases the chances that evidence will get lost or you will forget important details about the accident. Forgetting details about the accident and losing evidence could make it harder to prove the validity of your claim, ultimately leading to it being denied.

Your Injury is Not Related to Your Job

Under Louisiana Revised Statutes Title 23: 1021, the incident that led to your injury had to have arisen out of and in the course of your employment to qualify for workers’ compensation. This means that you had to be engaging in an activity that was considered part of your job when your injury occurred.

In most cases, it does not matter who was at fault for the accident. However, your claim will be denied if the injury was caused by willful or intentional actions that were intended to injure yourself or others, according to the Louisiana Workforce Commission.

Your claim will also be denied if the employer proves:

  • You were engaged in horseplay at the time of the accident
  • You were the aggressor in an unprovoked physical altercation

You Were Intoxicated at the Time of Your Accident

If your employer has a written drug policy and does a drug test after your accident and finds out that your injury was caused by your intoxication, your Louisiana workers’ compensation claim will be denied unless the accident was unavoidable. The only exception to the rule is when an employee was intoxicated because he was engaged in activities related to the employer’s interests or activities in which the employer encouraged the use of an intoxicating beverage or substance.

Your Mental Injury Lacks Evidence

You can recover workers’ compensation for some types of mental injuries (Louisiana Revised Statutes Title 23:1021(8)(b)-(c)), whether the injury was caused by mental stress or a physical injury. However, you need clear and convincing evidence that the injury was a result of a physical injury or sudden, unexpected or extraordinary stress related to your job.

The mental injury must also be diagnosed by a licensed psychiatrist or psychologist and meet the criteria established in the Diagnostic and Statistical Manual of Mental Disorders presented by the American Psychiatric Association.

You are Not Classified as an Employee

Full-time, part-time and seasonal employees, including minors, are all entitled to workers’ compensation benefits if they suffer a qualifying injury. Subcontractors and independent contractors could be considered employees if they perform substantial manual labor or are involved in the pursuit of the employer’s trade.

If you do not fit those classifications, you are not entitled to benefits, regardless of how serious your injury is or who is at fault.

However, it is possible that your employer misclassified you as someone who is not entitled to workers’ compensation. Our attorneys can review your situation to determine if you were improperly classified and deserving of benefits.

If you file a workers’ compensation claim and the insurance company denies it, the Baton Rouge injury attorneys at Simien & Simien can help. We have many years of combined experience helping employees recover fair compensation for their injuries.

Schedule your free, no-obligation legal consultation today to find out if we can help you.

Call (800) 374-8422 or complete our Free Case Evaluation form.