Although some employees are lucky and have positive experiences when dealing with the workers’ compensation insurance company, it is critical to recognize that Insurance companies are not on our side. Oftentimes, employees report a legitimate claim to their employer, which is passed on to the workers’ compensation insurance company, and it results in a denial.
Here we will review the types of denials that people regularly contact our office to discuss.
1. The Employer Claims No Employer-Employee Relationship
To have a valid workers’ compensation claim in Iowa, there must first be an employee-employer relationship. If the employer can undercut this first element, the entire claim fails. Most commonly this occurs where employees were actually independent contractors- a class of employees not covered by Iowa Workers’ Compensation laws.
However, it is important to recognize that there is not necessarily a clear divide between employee and independent contractor. In these types of situations, a consultation with an experienced Iowa workmans’ comp attorney could help you make this determination.
2. The Insurance Company Says There is No Qualifying Workers’ Compensation Injury
This can happen in a few instances.
Pre-existing condition means a worker is denied work comp benefits:
A pre-existing condition does not mean that your claim should automatically be denied. Under Iowa law, an injured worker is entitled to workers’ compensation benefits whenever a work activity aggravates, accelerates, worsens or reveals an underlying or pre-existing condition.
Whether or not a particular claim is covered depends largely on the medical evidence – in particular, the treating doctors’ opinions. Many cases involving an aggravation of a pre-existing condition which were initially denied are ultimately determined to be covered after an experienced attorney properly questions a treating doctor.
The work injury was not caused by the employment:
There must be a connection between the injury and the employment. Specifically, the injury must be a result of the employment: it must arise out of and in the course of employment. This may sound like legal jargon, but it is a critical aspect of bringing a workers’ compensation claim. Simply put, the injury must be caused by the employment.
It is common for insurance companies to attack the validity of a work injury in relation to whether the employment caused the injury.
Proper notice of the work injury was not given:
Most people are aware that some type of statute of limitation applies to their claims. What they may not be aware of is there is an additional notice requirement under Iowa Workers’ Compensation laws. In order to have a valid claim, the employer must have been given notice of the injury within 90 days of the work injury.
It is a terrible thing when someone has a valid workers’ compensation claim but it is denied because they did not give proper notice. Consult with an experienced attorney to ensure that this situation does not happen to you.
If you need additional information, download our free Law Guide to Iowa Workers’ Compensation Claims.