Claim Denial Due to Unexplainable Injury
August 28, 2019
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It happens all the time. You take on an injury without noting what you were doing just beforehand. The issue with the Workers’ Compensation Commission within Virginia is that they require you to explain how you received your injury.

They don’t want a simple, “I fell” answer either. The Commission wants a full explanation of the events that led up to the accident. They also expect an account of how the accident contributes to your injury.

For example, they want something like, “I fell while carrying a box. I was unable to see what was in front of me because of the box and tripped. When I fell, I fell onto my wrist, which led to the sprain.” However, very few people can recount their accidents this way. The example here was a straightforward and direct accident. What about complicated accidents? What about the more traumatic accidents?

Claim Fraud is Real and Leads to Many Denials

The issue around unexplainable injuries is that the insurance company suggest fraud. They imagine that someone is making up an injury in an attempt to recover a partial wage while sitting at home. It’s an unfair conclusion to jump to, but in all fairness to the insurance company, fraud does happen.

You can work with a workers’ compensation attorney to show your vision of events. Additionally, you should document the accident as soon after the incident as possible. The insurance company may not accept explanations such as you tripped or fell. However, they do need to listen to reason and give fair consideration to your claim.


Explaining How You Were Injured

When explaining how you took on your injury, you’ll want to assess the environment. What led to your injury, what happened right before, and what were you doing? There are a few areas within these questions where insurance companies will try very hard to avoid making a payout.

As you report your injury, you need to be sure that you’re covering all of your bases. For many people, you’ll need to do everything just short of noting how the company failed to protect you. Citing wetness on the floor, a lapse in policy or other unsafe working conditions is vital to your claim.

One primary facet that comes into play is violating company policy. Often when people are explaining how the accident happened, they’ll tell the event as it should have happened. If everyone involved had followed company pokily.

Violating Company Policy and Fear of Termination

The present fact is that many companies have policies that the employees have never heard of before the accident. Then they are left out with a medical bill and days missed at work because of a mystery policy.

Alternatively, there is the policy implementation gap which plagues many workers’ compensation claims. In these situations, the employee quite possibly knew the policy. However, they may have received constant direction, which was against the policy from their managers. These cases often leave people feeling that they can’t put in a claim. The employee knows that the accident happened because company policy was not followed.

If this is the case in your claim, you may have an unexplained injury because you are reluctant to expose your manager or supervisor. The person who was instructing you to go against company policy. There may even be a fear of termination.

It’s apparent for many doctors that these injuries come from the workplace, and the injuries are present. So it’s not that someone is lying about an injury taking place. In these situations, you can turn to legal guidance.

A workers’ compensation attorney can help you show how management nullified company policy. It’s difficult for many people to handle. However, your workers’ compensation claim may expose dangerous and unsafe working conditions.

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Find a Workers’ Compensation Attorney in Alexandria, VA

Working with an Alexandria, VA workers’ compensation attorney can help you build a strong case regardless of any unexplainable injuries. If your employer is refusing to provide benefits, then you need someone to argue for your side. Fraud is a serious accusation, and you may feel that you’re under attack. Unexplainable injuries often receive denial claims that may accompany allegations of an attempt at fraud.

Call Ashcraft and Gerel, the law office that helps injured workers fight for their compensation. An insurance company will likely not give you a fair review or a fair settlement. Work with an Alexandria, VA workers’ compensation attorney who is willing to fight for your case and take it to a full resolution.