Reasons Your Workers’ Compensation Claim Could Be Denied in Massachusetts

Workers’ compensation is a benefits system that allows injured employees to collect compensation for work-related accidents. The process for filing for workers’ compensation is long, complex, and challenging. Many injured workers are denied when they first file.

There are many reasons your workers’ compensation could be denied. For example, your claims might be viewed as less trustworthy if you waited to report the accident. Alternatively, your claims could be denied if your accident is unrelated to your job or your injuries do not prevent you from returning to work. Pre-existing conditions do not bar compensation but may place higher scrutiny on your case. If you do not meet the legal definition of an employee, you may be denied as well. If your claims are denied, our legal team can help you file

.an appeal.

If your claims for workers’ compensation were denied, our Massachusetts workers’ compensation lawyers can help you appeal your case and get the compensation you need. Call the Law Office of John J. Sheehan at (617) 925-6407 for a free case review.

Common Reasons Workers’ Compensation Claims Are Denied in Massachusetts

Filing for workers’ compensation does not automatically get an injured worker their compensation. You may have to prove the extent of your injuries and explain how the accident happened. The process can take a while and is somewhat complex, and many applicants are unfortunately denied. If your case is denied, it does not mean that you do not deserve compensation. Our Boston workers’ compensation lawyers can help you appeal your case.

The Injury Was Not Reported Right Away

Many claimants are denied because they did not report their accident right away. When a job-related accident occurs, you must report the accident and your injuries to your employer so they can notify their insurance company. If you wait to notify anyone about the accident, precious time is lost, and your claim may be weaker for it.

In some cases, people wait to report their accident because they do not feel injured. Injuries do not always reveal themselves until later. For example, if a worker falls on the job and injures their back, but they can quickly return to work, they might feel no need to report the accident. However, their injured back could worsen over time into chronic back pain. a long time might have elapsed by the time the accident is reported.

Alternatively, the failure to notify might lie with your employer. Some employers are negligent and do not report on-the-job accidents to their insurance. In the end, it is the employee who suffers.

The Accident Was Not Related to Your Job

Your accident must be related to your job to qualify for workers’ compensation. Just because an accident happens while you are on the clock does not necessarily mean it is job-related. For example, if a delivery driver is injured in a car accident while making deliveries, this might constitute a job-related accident. However, if the accident happened while the employee was off the clock or running personal errands on company time, the accident might be outside the scope of their employment.

Often, the line between what is inside or outside the scope of employment is blurry, and injured employees end up being denied workers’ compensation because of confusion over the issue. Our Cambridge workers’ compensation lawyers can help you clarify the nature of your accident in your appeal.

Your Injury Does Not Hinder Your Ability to Work

Even if you can establish that your accident happened within the scope of your employment, you must meet certain other criteria. to qualify for workers’ compensation, you must be prevented from working for at least 5 full days after your accident. These days do not have to run consecutively.

Injuries can be unpredictable and do not always leave you completely disabled or incapacitated. If you could return to work but had to take days off here and there, your claims for worker’s compensation might be seen as weak because you are continuing to work. However, once you meet the 5 days threshold, you become eligible. Our Wakefield workers’ compensation attorneys can help you appeal an unfair denial.

You Have a Pre-existing Condition

Pre-existing conditions are medical conditions you might have had before being injured at work. For example, if you broke your right arm in a work-related accident, but your left arm was previously broken in an accident outside of work, workers’ compensation would cover only your right arm. Your broken left arm would be considered a pre-existing condition.

In many cases, a pre-existing condition cannot be so neatly disentangled from a work-related injury. For example, if you injure your back in a work-related accident and have a bad back from an old injury, it may be hard to distinguish how much your new injury is connected to your work-related accident.

When a new work-related injury and a pre-existing condition merge, your claims for workers’ compensation may be more heavily scrutinized to prevent any overpayment. Unfortunately, this tends to lead to unnecessarily denied claims.

You Are Not an Employee Under the Law

Only employees can file for workers’ compensation. According to Mass. Gen. Laws Ch. 152 § 1(4), most workers are considered employees with a few exceptions. For example, independent contractors, seamen who work in interstate or foreign commerce, certain taxi drivers, and several others are not considered employees under the law.

If it is not clear what the nature of your job is when you file for workers’ compensation, your claim could be denied. Our Somerville workers’ compensation attorneys can help you clarify that you are indeed legally considered an employee eligible for workers’ compensation.

What Should I Do If My Workers’ Compensation Claim is Denied in Massachusetts?

If your claim is denied, you can file an appeal. According to Mass. Gen. Laws Ch. 152 § 11C, you have 30 days from the denial of your claim to file an appeal. Your appeal will go before a reviewing board that will examine your case. The reviewing board may reverse the decision of the administrative judge who denied you under specific conditions:

  • The administrative judge’s decision exceeded the scope of their authority.
  • The administrative judge’s decision was arbitrary or capricious.
  • The decision to deny you was contrary to law.

In some cases, the reviewing board can send your case back to an administrative judge for further findings of fact. Our Milton workers’ compensation lawyers can help you file your appeal and hopefully get you a second chance at compensation.

Call Our Massachusetts Workers’ Compensation Attorneys for Advice

If you filed for workers’ compensation and were denied, our Malden workers’ compensation lawyers can help you file an appeal. Call the Law Office of John J. Sheehan at (617) 925-6407 for a free case review.