Reasons a Workers Compensation Insurance Claim Might Be Denied in Texas

workers compensation insurance in Texas

Contrary to popular belief, workers compensation benefits are not available to just anyone who is injured on the job. In order to be eligible, the injury and the circumstances leading up to it must meet certain standards and the claim itself must meet strict criteria. Workers compensation law is not cut and dry, and if you are someone who deals with workers compensation insurance in Texas in any capacity, you may benefit from knowing what may lead to a claim denial.

Deadlines Werent Met

In Texas, a claimant must adhere to a certain timeline in order to have their claim heard. They must report the injury to their employer within 30 days, appeal any medical decisions within 90 days and file the official claim within one year. If they fail to meet any deadlines, their claim will be dismissed.

The Claim Was Inaccurate

The details of a workers compensation claim must be wholly accurate in order for the claim to be valid. If one detail is wrongeven if its something as minor as the location of the puddle slipped onit could ruin a claimants entire case.

The Claimant Was at Fault

If it is discovered that the claimant was goofing off, intoxicated or involved in criminal activity at the time of the injury, they are not eligible for workers compensation benefits. The same is true if the accident occurred outside of the normal scope of employment.

There are several reasons a claim filed under workers compensation insurance in Texas may be denied, but the above three are the most common.