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What are some common sense reasons a workers’ compensation claim is denied?

When your claim is denied, it doesn’t mean that this is the end of the road.  Insurance companies often deny work injury claims as a matter of course, even though the claims may still have merit.  If you feel that your claim is valid even though you received a denial or your benefits were stopped, you should speak with an attorney about appealing the decision and filing suit or an appeal(link to appeals).  Here are some common reasons why workers’ compensation claims are denied:

  1. Failure to give notice.  When you are injured in a work accident, you are required to give your employer notice of your injuries.  The notice must happen within a reasonable period of time, or the insurance company can question or even deny your claim.
  2. Willful negligence. Under Nebraska Workers’ Compensation Law, you can still qualify for workers’ compensation benefits even when you caused your own injury, as long as your injury was not the result of willful negligence on your part. If the insurance company claims that you were willfully negligent, your attorney can appeal the decision and defend you in your claim.
  3. Not in the course of employment. When you file a claim, you are asserting that your injuries happened as part of the course of your employment.  If the insurance company believes that you were acting for your own personal benefits, you were off the clock, or what you were doing was far outside of your job description, they may attempt to deny your claim.
  4. Not an employee. In some complicated situations, the insurance company or insurer may argue that you were not employed by the company, that you were an independent contractor, or that another company is responsible for your injuries.
  5. Medical denial. Insurance companies often argue that your work injuries are nonexistent, not severe, or that they have healed enough for you to return to work.  They can do this through investigations or  insurance company hired medical examinations

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