How Workers’ Compensation Claims Are Denied

Workers hurt on the job may never expect to end up with a denied claim. However, it's important for hurt workers to be ready for denial and to know what to do next. Don't allow a workers' compensation insurance denial to cancel your case. Learn what happens to cause denials and what to do afterward.

Workers' Comp Denial Issues

Here are some of the most common reasons why workers' compensation claims are denied:

Failure to seek medical treatment: If the injured worker fails to seek medical treatment for the injury or illness, the claim may be denied. The lack of action sends a message that the injury is not severe enough to qualify for coverage.

Failure to report the injury in a timely manner: Many states require that workers report injuries to their employers within a specific time frame. If the injury is not reported within this time frame, the claim may be denied.

Lack of medical evidence: In order to be eligible for workers' compensation benefits, there must be medical evidence that the injury or illness is work-related. Workers should report to a doctor as soon as possible to avoid a lack of medical evidence.

Dispute over the cause of the injury: If the employer or their insurance company disputes that the injury or illness is work-related, the claim may be denied.

Pre-existing condition: If the injured worker had a pre-existing condition that contributed to the injury or illness, the claim may be denied or limited.

Violation of company policies or safety rules: If the injured worker was violating company policies or safety rules at the time of the injury, the claim may be denied.

Statutory limitations: Workers' compensation laws vary by state, and there may be limitations on the types of injuries or illnesses that are eligible for benefits.

Dealing with Denials

Know that you are not alone in your denial of benefits. Workers' comp insurers can be difficult to work with and suspicious of fraudulent claims. Take these actions after a denied claim:

Contact the insurer. You may be able to add additional information to the claim or gather more evidence of your injury and have the claim reinstated. 

Keep paperwork organized. Save everything in a file case for access later. If you speak on the phone with your employer or the insurer, make notes during or after the call. 

Workers' compensation lawyers understand the complexities of workers' comp laws. They also know how you can stand up for your rights and be paid what you deserve. Speak to a lawyer today about your case today.