Although workers’ compensation is intended to allow employees who are injured at work to receive compensation more quickly and easily than filing a lawsuit, the claims process can be complicated. A claim can be delayed or denied for a variety of reasons.
1. Delay in Reporting
The first step in obtaining Iowa workers’ comp benefits is to give notice to your employer or its agent that you have suffered an injury in the course of your employment, on or about a specified time, at or near a certain location. This notice must be given within 90 days after the “occurrence of the injury,” a date which can sometimes be difficult to determine (such as for chronic conditions that develop gradually). Your claim can be denied if the workers’ comp insurer determines that you failed to give timely notice, so notify your employer as soon as possible if you suffer an injury at work or suspect you may have a work-related condition.
2. Employment Status
Iowa workers’ compensation protection covers only workers considered by law to be employees; an independent contractor isn’t eligible to file for workers’ compensation for a work-related injury. This status depends on how much control or autonomy you have in performing your job duties. However, just because an employer tells you that you are an independent contractor does not mean that you are correctly classified under the law. If you have been injured at work and denied benefits, talk to an experienced attorney about whether your work status may be misclassified.
3. Non-Work-Related Injuries
Workers’ compensation covers only “work-related injuries.” To obtain benefits, a worker must establish that he or she was engaged in work-related activities when the injury occurred or developed and that the nature of those work activities contributed to the injury’s development. Especially in cases where employees travel for work, work from home, or spend time on activities that have both work-related and personal aspects, it can be difficult for an insurer to properly determine whether an injury meets the eligibility requirements. You may need to collect and present evidence to establish the validity of your claim in order to receive benefits.
4. Pre-Existing Conditions
Workers’ comp will not pay benefits for “pre-existing conditions,” i.e., medical issues or problems that a worker already has when they suffer a compensable on-the-job injury. If you suffered a previous injury to the same body part as your current injuries, or if there is evidence you suffered from a pre-existing medical issue that impacts your current condition, your claim may be denied or your benefits reduced. However, your workers’ compensation insurer is responsible for the aggravation, acceleration or “lighting up” of an underlying medical condition or pre-existing injury. Therefore, just because you are told your claim is denied because of a pre-existing condition, it does not mean your claim is not compensable.
5. Significant Misconduct/Fault
Generally, who is responsible for an employee’s injuries doesn’t affect his or her eligibility to collect from the workers’ compensation system. However, certain contributory factors are significant enough to warrant denial of a claim. If an employee sustains injuries as a result of their own intoxication, for example, the claim may be denied. Insurers may also deny coverage if an employee’s misconduct caused the injuries. Because the system is intended to be “no fault,” however, you may be able to successfully challenge an initial denial based on these grounds.
6. Not serious enough injury
Workers’ comp is intended to compensate employees for injuries that are serious enough to require medical treatment or time off from work. For some delayed-onset injuries or chronic conditions, employees may continue to report to work despite pain or impairment. This can cause an insurer to contest the severity of the claim and deny coverage. To be safe, it’s best to report any injuries or pain immediately to your employer and get treatment for your injury as soon as possible.
Workers’ Compensation Advocacy for Iowa Employees
Recent changes to Iowa’s workers’ compensation statute could make the claims process more difficult and reduce benefits for injured workers. An experienced workers’ compensation attorney will be your advocate through the claims process and can help you recover benefits like lost wages, paid medical care, and partial or total permanent disability benefits if appropriate. If you have been denied workers’ compensation benefits or need to begin the claims process, contact us today.