A workplace injury can be a life-altering event, leaving you with physical pain, emotional distress, and lost wages. Michigan's workers compensation system is designed to provide financial assistance to employees who suffer work-related injuries or illnesses. However, navigating the worker's compensation process can be complex, and unfortunately, not all claims are approved.
Bruce Weider, a Michigan worker's compensation attorney, explores eight common reasons why worker's comp claims get denied in Michigan and offers guidance on how to protect your rights.
Understanding Workers Compensation in Michigan
The Michigan Workers' Disability Compensation Act (WDCA) outlines the legal framework for worker's compensation. Under the WDCA, employers are required to carry worker's compensation insurance to cover medical expenses, lost wages, and vocational rehabilitation for employees who sustain work-related injuries or illnesses.
While the system aims to be efficient, there are situations where claims are denied. Here are eight of the most common reasons for worker's compensation claim denials in Michigan.
1. Failure to Report the Injury on Time
Timeliness is crucial when it comes to worker's compensation claims. According to Michigan law, you must notify your employer about your work-related injury within 90 days of its occurrence (Mich. Comp. Laws § 418.301 [invalid URL worker's compensation act 418 ON Michigan Legislature legislature.mi.gov]). This notification can be done verbally or in writing, but it's important to document it for your records. If you fail to report the injury within the 90-day window, your claim can be denied, even if it's a legitimate injury.
2. Difficulty Proving the Injury Was Work-Related
The burden of proof lies with the employee to demonstrate that their injury or illness arose from their employment. This can be challenging, especially for injuries that develop over time or for conditions with multiple contributing factors. Having clear documentation of the accident, such as witness statements, accident reports, and medical records linking the injury to your work activities, significantly strengthens your claim.
3. Missing or Incomplete Medical Records
Medical documentation plays a vital role in establishing the nature and extent of your work-related injury. Incomplete or missing medical records can raise doubts about the severity of your injury and its connection to your job duties. Ensure you attend all scheduled medical appointments with doctors authorized by the worker's compensation insurance company and obtain copies of all your medical records related to the injury.
4. Not Following Treatment Recommendations
If you fail to follow the treatment plan outlined by the authorized physician, your worker's compensation benefits may be suspended or even terminated. This includes attending all doctor's appointments, taking prescribed medications, and participating in any recommended physical therapy or rehabilitation programs. If you have concerns about the treatment plan, discuss them with the doctor and seek guidance from your worker's compensation attorney.
5. Pre-Existing Conditions
Michigan worker's compensation law acknowledges pre-existing conditions. However, if a work-related injury aggravates a pre-existing condition, you are still entitled to benefits for the aggravated portion of your injury. Providing clear medical evidence demonstrating how the work injury worsened your pre-existing condition is crucial.
6. Being Under the Influence When Injured
If you were under the influence of alcohol or drugs at the time of the accident, your worker's compensation claim may be denied. Michigan law allows employers to deny benefits in such situations.
7. Filing for Unemployment Benefits While Receiving Workers Comp
While receiving worker's compensation benefits, you are generally not eligible to collect unemployment benefits. Doing so can raise red flags and lead to the denial of your worker's compensation claim.
8. Minor Injuries Deemed Not Disabling
Michigan worker's compensation benefits are intended for injuries that result in lost wages or a temporary or permanent disability that prevents you from performing your job duties. If your injury is deemed minor and does not cause you to miss work or significantly impact your ability to perform your job, your claim may be denied.
What to Do If Your Worker's Comp Claim Gets Denied
If your worker's compensation claim is denied, don't give up. The Michigan Workers' Compensation Agency provides resources and information on the appeals process. Here are some important steps to take if your worker's compensation claim is denied:
- Request a Hearing: You have the right to request a hearing with a Workers' Compensation Magistrate within 60 days of receiving your denial notice. A magistrate will review your case and issue a decision.
- Consult a Worker's Compensation Attorney: An experienced worker's compensation attorney can analyze your case, identify the reasons for the denial, and advise you on the best course of action for appealing the decision. Worker's compensation attorneys are familiar with the complexities of the system and can advocate for your rights throughout the appeals process.
- Gather Additional Evidence: If your initial claim lacked sufficient evidence, use this opportunity to gather additional documentation to strengthen your case for the appeal. This may include witness statements, medical records not previously submitted, or expert opinions supporting the work-related nature of your injury.
Remember, You Have Rights
Worker's compensation is designed to protect injured workers and their families. If you've been denied benefits you deserve, don't hesitate to seek legal representation and fight for your rights. Bruce Weider, a Michigan worker's compensation attorney, is dedicated to helping injured workers navigate the system and obtain the compensation they are entitled to.
Contact Bruce Weider Today
A work-related injury can be a significant setback, but you don't have to face it alone. If you have been injured on the job and your worker's compensation claim has been denied, contact Bruce Weider today. We offer a free consultation to discuss your case and explore your legal options. With our experience and knowledge of Michigan worker's compensation law, we can help you fight for the benefits you deserve.
Call us at (734) 485-0535 or visit us online to schedule your free consultation today.
