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Could My Employer Deny My Workers’ Compensation Claim?

Under the Workers’ Compensation laws in Tennessee, most businesses having more than five employees must carry insurance to cover any injuries sustained by workers on the job. With certain exceptions, virtually every injury incurred by workers on the job is eligible for workers’ compensation coverage. Although the employer cannot deny your workers’ comp benefits outright, they may make it difficult for you to obtain the compensation you need for your lost income and medical expenses.

Work injury claim denied

Reasons for a workers’ compensation claim denial

Many people may think that the workers’ compensation process is automatic and the majority of claims are quickly approved. However, workers’ compensation claims happen all the time, for a variety of reasons.

In addition, Tennessee law requires that work activities leading to an injury must be greater than 50% of the cause of the injury or need for treatment. As an example, if you were horsing around in the workplace and sustain an injury as a result, the insurance adjuster may claim you are not eligible to receive workers’ compensation.

Some common reasons why an insurer may deny your workers’ comp claim include:

  • You did not file your claim with the Department of Labor and Workforce
  • You failed to report your injury to your employer within 30 days
  • Your injury was caused by self-inflicted harm, or as a result of not using proper safety gear
  • Your injury occurred at a paid company outing or during other recreational activity
  • You sustained the injury while intoxicated, high on drugs, or after using any type of illegal substance
  • You failed to seek medical treatment
  • You did not use the doctor or medical provider approved by your employer

What if my employer contests my workers’ comp claim?

Employees in Tennessee are required to report workers’ compensation claims within one day of learning of the accident. However, they are not obligated to agree with the worker on all the specifics of the claim. Depending on your specific circumstances, your employer may contend that your injury did not occur on the company’s time. Or they may claim you failed to meet the eligibility requirements for workers’ comp based on any of the reasons mentioned above.

Hiring a workers’ compensation attorney is the best option when filing a claim. The employer’s insurer is likely to believe the word of your employer over you while assessing your claim. Even if your employer uses a neutral mediation specialist to resolve your claim, that may not be sufficient to change your employer’s mind about your claim. In addition, filing a claim prevents you from filing a lawsuit against your employer, reinforcing the need to use the services of a workers’ comp attorney.

Can I appeal if my claim was denied?

You have the right to appeal a denial of your claim within 60 days. You’ll need a good lawyer to help you, though, and that is where we come in.

At the Rocky McElhaney Law Firm, we serve clients who have been injured in the workplace from our offices in Nashville, Hendersonville, and Knoxville, Tennessee. We fight for compensation you deserve for your injuries. To schedule a free, no-obligation consultation, call us today at 615.425.2500 or send us a message through our contact form.