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Workers Comp Claims & Denials

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Work comp insurance companies can deny a claim on almost any basis. This is how insurance companies avoid paying claims, because they know that a certain percentage of people will never hire a lawyer or pursue a claim if it has been denied. This is particularly true where the injured worker has health insurance or other benefits available – many people are simply afraid to call a lawyer or don’t know where to begin when their claim has been denied.

When it comes to a pre-existing condition, such heath matters may have some impact on whether you have a legitimate work comp claim. However, the simple fact that you have had some prior back problems, for example, does not necessarily disqualify you from bringing a claim for current back problems related to a work injury or your work activities. The issue is more complicated than that.

The real question is whether your prior back problems were affecting your ability to work or limiting your physical or other activities prior to the work incident. Many people have back problems or other physical ailments which intermittently give them some problems but “come and go”. If a work injury or your regular work activities significantly aggravates or accelerates a pre-existing condition to the point where you now need medical care and may need some physical restrictions or limitations, then you probably have a work comp claim.

Another common issue arises where a person has had a prior work comp claim involving the same body part.  Let’s say you had a back injury 10 years ago which was treated as work comp. The insurance company paid you wage loss and medical benefits but you were able to return to work. Now, you have had a new back injury or your work activities have gradually caused an increase or return of your back problems. The claim could be against the same or a new employer, but there will probably be a different work comp insurance company involved since your claim from 10 years ago.

This is a work comp claim, but you can almost be assured there will be a dispute between the current work comp insurance company and the company that provided coverage 10 years ago when you filed your prior claim. In all likelihood, the claim will be covered by one insurance company or the other, but there may be a delay in obtaining benefits while the insurance companies slug it out between themselves.

If you find yourself in a situation where your claim has been denied because the insurance company says you have a pre-existing condition, or if two insurance companies are each arguing that the other is responsible, it’s time to contact an attorney. The insurance companies have lawyers and other experts protecting their interests and they are not looking out for yours. An experienced attorney can review your medical records, any prior work comp records and help explain possible options.  

If you or a loved one are injured at work, contact the attorneys at LDM&M.   Acting promptly to preserve your rights is essential after any accident.  For over 40 years, the attorneys at LDM&M have been helping individuals across Wisconsin receive the legal satisfaction that they deserve.  Contact our offices for a free, personal consolation.