According to the Nebraska Department of Labor, there are over 1 million employees in the state. When injured at work, employees in Nebraska may seek financial assistance through a workers’ compensation claim. However, not all claims get approved.
Several reasons could lead to the denial of these claims, and workers need to understand what they can do to help their claims get accepted.
1. Claim submission timing
Nebraska law mandates that employees report injuries to their employer within 10 days. Failure to meet this deadline can result in a claim denial.
2. Lack of medical evidence
Medical evidence plays a crucial role in validating a workers’ compensation claim. If an employee cannot provide sufficient medical proof to substantiate the injury or the extent of it, the insurance company may deny the claim. It is necessary to keep thorough records of all medical appointments, diagnoses and treatments related to the workplace injury.
3. Injuries outside the workplace
Workers’ compensation only covers injuries that occur within the scope of employment. Any injury that does not directly connect to the employee’s job responsibilities can result in a claim denial. Therefore, if an employee sustains an injury outside of work or during activities not related to their job duties, the claim might not stand.
4. Insufficient details about the accident
When filing a workers’ compensation claim, providing a detailed account of the accident is essential. This description should include the location, time and how the accident happened. If the employee provides insufficient or inconsistent details, the insurance company could find grounds for claim denial.
5. Discrepancies between accident reports and medical records
Insurance companies scrutinize accident reports and medical records closely. If they find discrepancies between the details in the accident report and those in the medical records, they might deny the claim. For example, if an injury mentioned in the medical records does not appear in the initial accident report, the insurance company might question the validity of the claim.
6. Evidence of illegal activities or policy violation
If an employee was violating company policy or engaging in illegal activities at the time of the injury, workers’ compensation claims might face denial. Evidence of drug use, for example, could lead to a claim denial.
Understanding these common reasons for claim denial can help employees navigate the workers’ compensation claim process more effectively in Nebraska.