Getting hurt at work is difficult enough without your employer challenging your version of what happened. Unfortunately, Louisiana workers sometimes report an injury only to hear that their employer disputes the accident, questions whether it happened at work, or claims that the employee’s medical condition is unrelated to the job.
An employer refuting your claim does not necessarily end your right to workers’ compensation benefits. It does mean that evidence becomes especially important. At Wanko Workers’ Comp Lawyers, we represent injured employees throughout Louisiana when employers and insurance companies challenge workers’ compensation claims.
Employers may dispute workers’ compensation claims for many reasons.
Sometimes there is a genuine disagreement about how an accident happened. In other cases, an employer may question whether an injury occurred during the course and scope of employment.
Common disputes involve allegations that:
Our Louisiana workers’ compensation attorneys help injured employees address these disputes and pursue the benefits available under Louisiana law.
Your employer can dispute your claim, but an employer’s disagreement does not necessarily determine the final outcome.
Louisiana workers’ compensation claims often involve the employer’s insurance carrier as well. The insurer may investigate the accident, review medical evidence, obtain statements, and decide whether it will voluntarily pay benefits.
When a claim remains disputed, the matter may ultimately need to be addressed through Louisiana’s workers’ compensation system.
This is an important distinction. Hearing your supervisor say, “We don’t believe this happened at work,” can be discouraging, but that statement alone does not necessarily establish whether you are legally entitled to benefits.
Evidence matters.
Some workplace accidents occur without witnesses.
A Louisiana employee might injure a back while lifting equipment in an isolated work area or hurt a knee while performing a task when no coworkers are nearby.
The absence of a witness does not automatically mean the accident did not occur.
However, a disputed unwitnessed accident can make documentation especially important.
Evidence may include:
Consistency can also become significant. If descriptions of the accident vary substantially between an incident report, medical records, and later statements, an employer or insurer may use those differences to challenge the claim.
Prompt reporting is important after a Louisiana workplace injury.
Waiting to report an accident can create both legal and evidentiary problems. An employer may argue that if you were actually injured at work, you would have said something immediately.
Real situations are not always that simple.
Some workers initially believe an injury is minor. A person may finish a shift expecting back soreness to disappear, only to wake up the next morning unable to move normally. Other injuries may become progressively worse.
If there was a delay, preserve evidence explaining what happened.
Perhaps you told a supervisor verbally but no written report was prepared. Maybe coworkers heard you discuss the injury. Medical records may document that you reported a work accident when you first sought treatment.
The details can matter when an employer refutes the claim.
Pre-existing conditions frequently become an issue in Louisiana workers’ compensation disputes.
Suppose you previously experienced back pain and then suffer a new lifting injury at work. Your employer or its insurer may argue that your current symptoms are simply the result of the old condition.
A prior medical problem does not automatically eliminate the possibility of workers’ compensation benefits.
The question may instead involve whether the workplace accident aggravated or worsened the condition.
Medical evidence can be critical.
Records showing your condition before the accident can be compared with examinations, diagnostic testing, symptoms, and treatment afterward. Your treating physician’s opinions about causation may also become important.
Do not hide a previous injury from your doctor or attorney. An undisclosed medical history can create credibility problems if the insurer discovers it later.
When an employer refutes a Louisiana workers’ compensation claim, medical records can become some of the most important evidence in the case.
Tell your healthcare providers accurately how the injury happened.
If you hurt your shoulder lifting materials at work, explain that. If repetitive job duties gradually caused your symptoms, describe those duties accurately.
Important medical evidence may include:
Gaps in treatment can also become an issue. An insurer may argue that long periods without medical care suggest that the injury was not serious or that later symptoms came from another cause.
Follow your doctor’s recommendations and keep copies of important records.
Workers and employers sometimes tell very different stories about the same event.
Your supervisor may claim you said you were hurt at home. You may remember clearly explaining that the injury happened while lifting something at work.
These factual disputes require evidence.
Contemporaneous documentation can be particularly useful because records created close to the time of an accident may help establish what was being reported before a legal dispute developed.
Save emails, text messages, incident reports, photographs, and other communications related to your injury.
Do not alter documents or attempt to persuade witnesses about what they should say. Preserve the evidence as it exists.
Yes.
Not every Louisiana workers’ compensation case involves a sudden accident.
Some employees develop medical conditions because of occupational exposures or repetitive work activities. These claims can generate disputes over whether employment actually caused the condition.
An employer may argue that the employee’s condition resulted from age, activities outside work, an unrelated illness, or another cause.
These cases can depend heavily on medical evidence connecting the diagnosed condition to the employee’s job.
Detailed information about your actual work duties may help your physician understand the physical activities or exposures involved.
For example, simply saying that you “work in construction” provides much less information than describing the repetitive lifting, tools, equipment, movements, or environmental conditions involved in your daily work.
If the employer or insurance carrier refuses to pay benefits, an injured worker may have options for formally pursuing the dispute.
Workers’ compensation disagreements can be presented through Louisiana’s workers’ compensation system, where a workers’ compensation judge may ultimately determine contested issues.
The exact strategy depends on why the claim was denied.
A dispute over whether an accident happened requires different evidence from a dispute over whether a particular surgery is medically necessary.
That is why it is important to understand the stated reason for the denial rather than simply resubmitting the same information.
A disputed claim is a reason to become more careful about documentation.
Consider taking the following steps:
You should also be cautious about recorded statements. If you provide one, answer truthfully and do not speculate about facts you do not remember.
An employer challenging your account can make a Louisiana workers’ compensation case more difficult, but the dispute does not automatically decide the claim.
Accident reports, witness testimony, medical records, workplace documentation, and other evidence may help establish what actually occurred.
At Wanko Workers’ Comp Lawyers, our practice is focused on helping injured Louisiana workers. Attorney Steve Wanko began his career representing insurance companies and businesses before founding his firm to represent workers’ compensation claimants. We understand how employers and insurers evaluate disputed claims and how important it is to build the evidentiary record carefully.
If your employer refutes your workers’ compensation claim, you do not have to assume that the employer’s version of events will control the outcome. Understanding why the claim is being challenged and gathering evidence that directly addresses that dispute can be critical.
If you are dealing with a disputed or denied workers’ compensation claim in Louisiana, our attorneys are here to help. Call us today or connect with us online to schedule a consultation.
