Five reasons why legitimate workers comp claims get denied

Michigan workers comp lawyer breaks down the top five reasons why employers and insurance companies dispute legitimate claims.

We see all kinds of reasons why employers and insurance companies dispute workers comp benefits. Some make sense while others are just plain stupid.

For example, we have a client who was denied lost wages because he was fired. The reason he was fired was because he got hurt at work. Confused? So are we.

It’s always fascinating to see why an employer or insurance company denies benefits. Here are five reasons why legitimate workers comp claims get disputed and what you can do to protect your legal rights.

1. Preexisting conditions

Insurance companies think of arthritis as a magic bullet that gives them permission to deny workers comp benefits. Somehow, the fact that a person was working without a problem until his or her work injury is always overlooked.

It is also common to see a preexisting condition that has not required treatment for many years be blamed. Just because an individual has a preexisting condition does not mean that his or her work injury is not legitimate.

2. The Monday injury

There is an old saying that you should never buy a car on a Friday. This is because auto workers will sacrifice quality when they are ready to leave for the weekend.  Some employers use this same faulty logic with work injuries.

Employers seem to go crazy when an injury happens at what they believe to be a suspect time or place. Don’t get injured on a Monday because your employer will suspect you just don’t want to work that week.

The same applies when there are no witnesses or the injury is reported later. The truth is that many people don’t realize the extent of their injury until after a few days.

3. Surveillance

Private investigates are routinely hired to perform activity checks on people claiming workers comp. Video surveillance is often taken out-of-context to show that an injury is fake. Employers and insurance companies assume that if you can go grocery shopping then you can work. However, there is a big difference between picking up some groceries and working five days a week for eight hours a day.

We have even seen some insurance adjusters make snap decisions about claims based upon what is posted on social media websites. Even when the medical evidence supports payment of the claim.

4. Asking to see your own doctor after 28 days

We have seen countless numbers of people who are told by insurance company doctors that their complaints are just subjective and there is nothing wrong with them. They are diagnosed with strains and sprains when in fact it is more serious.

Michigan law allows you to select your own doctor after 28 days. Employers and insurance companies don’t want you to treat with your own doctor and they assume you are just trying to prolong your disability. I would want a second opinion too if the doctor who just examined me for the insurance company is known as the “cut-off” guy.

5. Refusing to come back to unrestricted work

Since some employers only believe what their doctors have to say, it is no surprise that they expect you to return to unrestricted work. Some will even claim to offer favored work but then ignore your restrictions. When you cannot work because of pain, they call you a disgruntled employee and deny benefits. This is not right and should always be challenged in court.

To speak with one of our workers comp lawyers in Michigan, call (855) 221-COMP for a free consultation. We will fight to protect your legal rights. There is never a fee unless you receive workers comp benefits.

- Alex Berman is the founder of Michigan Workers Comp Lawyers. He’s been representing injured and disabled workers exclusively for more than 35 years. Alex has helped countless people obtain workers comp  benefits and never charges a fee to review a case.

Related information:

Video: Injured at work? Advice from a Michigan workers comp lawyer

Contact our Michigan workers comp lawyers

About Jeffrey Kaufman

Jeffrey E. Kaufman is a Michigan workers compensation attorney at the Law Offices of Alex Berman, PC. Jeffrey believes all injured workers deserve to be on equal footing with insurance companies and employers, and fights tenaciously so their rights are secured and protected.
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