When you pay an insurance provider a premium, you have the legal right to expect that the company will manage and act in an honest manner to pay out on any true claims you may have. If they don’t do this, they can be held legally responsible for what they did.
Each state has its own workers’ compensation system to try to cut down on the number of cases between employers and employees. Workers’ compensation means that if an employee gets hurt on the job, they are eligible for financial benefits. In return for these sure benefits, they promise not to sue their employers if they get hurt.
Reasons For Denying A Workers’ Compensation Claim
An insurance provider has a lot of reasons, some of which are good and some of which are not, to say no to your claim. Here are some of the most popular ones:
- Insufficient coverage: They may say that your insurance policy doesn’t cover your claim. Check the “Exclusions” part of your policy to learn more about what is not covered. If the policy isn’t clear, it is interpreted in favorable terms for the person who bought it, not the insurance company.
- Application mistakes: An insurance company could say that you lied on your original claim form in a way that makes your policy void.
- Claim errors: Check your insurance policy to see what you need to do to let the insurance company know about a claim. Some deadlines are only 24 hours long.
- Insurance fraud: False or inflated claims can be considered insurance fraud, which can lead to both civil and criminal penalties.
- Bad faith denial: They won’t tell you this, but an insurance company might give you a lot of confusing reasons for why they don’t want to pay the claim.
There are also other reasons why a workers’ compensation claim might be turned down,
- Not enough proof or paperwork
- Not telling anyone about the accident quickly or at all
- Not going to a doctor that the insurance-provider has approved
- Conditions that already existed
When Can I File a Lawsuit Against the Insurance Company?
Every insurance company owes its clients a lot of things. They have to follow the rules of the deal (the policy), act honestly, and not do anything that is unfair to the business. Most of the time, these responsibilities mean that the insurance company can’t:
- The claim was looked into too slowly and not well enough.
- Declining to compensate for a claim when it is pretty clear who is at fault.
- Not approving or rejecting a claim within a fair or set amount of time.
- Putting an end to a claim with very little explanation.
- Not defending you in an insurance case where at least one of the claims could be covered by your insurance policy.
- Refusing a claim because of a mistake on the application after the time for appealing has passed.