What to Do When Your Workers’ Comp Claim Gets Denied

Last Updat­ed on April 18, 2023 

As a work­er who has expe­ri­enced an injury on the job, you expect to receive com­pen­sa­tion through work­ers’ com­pen­sa­tion insur­ance. Unfor­tu­nate­ly, not all claims are accept­ed, and the rea­sons for claim denials can vary. Denied claims can be frus­trat­ing, con­fus­ing, and finan­cial­ly dam­ag­ing. As a work­ers’ com­pen­sa­tion lawyer, I have seen first­hand the dev­as­tat­ing effects of denied claims. In this arti­cle, I will dis­cuss com­mon rea­sons for claim denials and steps to take when your claim is denied.

Reasons for Workers’ Comp Claim Denial

1. Fail­ure to Report Injury: One of the most com­mon rea­sons for work­ers’ comp denial is the fail­ure to report the injury with­in the spec­i­fied time­frame. Most states require that employ­ees report the injury to their employ­er with­in a spe­cif­ic peri­od, rang­ing from a few days to a few months. If you fail to report your injury with­in that time­frame, your claim may be denied. 
2. Lack of Med­ical Evi­dence: Anoth­er rea­son for denied claims is the lack of med­ical evi­dence that the injury occurred on the job. With­out med­ical evi­dence, insur­ers may believe that the injury occurred out­side of work, which can lead to a denied claim. 
3. Pre-Exist­ing Con­di­tions: If you have a pre-exist­ing con­di­tion that is sim­i­lar to the injury you sus­tained on the job, your claim may be denied. Insur­ers may argue that your injury is not work-relat­ed, but rather a pre-exist­ing condition. 
4. Dis­put­ed Facts: Some claims are denied due to dis­put­ed facts sur­round­ing the injury. For exam­ple, if your employ­er dis­putes the sever­i­ty of your injury, your claim may be denied. 
5. Missed Dead­lines: There are dead­lines for fil­ing claims, appeal­ing denials, and sub­mit­ting evi­dence. If you miss any of these dead­lines, your claim may be denied.

Steps to Take When Your Claim is Denied

1. Review the Deci­sion: The first step to take when your claim is denied is to review the deci­sion to under­stand why it was denied. This can include review­ing med­ical records, speak­ing with your employ­er, and con­sult­ing with an attorney. 
2. File an Appeal: If you believe that your claim was wrong­ly denied, you have the right to file an appeal. This involves request­ing a hear­ing with the work­ers’ com­pen­sa­tion board to present your case. 
3. Gath­er Evi­dence: To strength­en your appeal, gath­er as much evi­dence as pos­si­ble. This can include med­ical records, wit­ness state­ments, and doc­u­men­ta­tion from your employer. 
4. Con­sult with an Attor­ney: Work­ers’ com­pen­sa­tion laws can be com­plex, and con­sult­ing with an expe­ri­enced attor­ney can help you under­stand your rights and nav­i­gate the appeals process. 
5. Fol­low the Dead­lines: It’s cru­cial to fol­low all dead­lines when appeal­ing a denied claim. Miss­ing a dead­line can result in the loss of your right to appeal. 

Denied work­ers’ com­pen­sa­tion claims can be frus­trat­ing and finan­cial­ly dam­ag­ing. How­ev­er, there are steps you can take if your claim is denied. Remem­ber to report your injury prompt­ly, gath­er med­ical evi­dence, and con­sult with an expe­ri­enced attor­ney. With prop­er prepa­ra­tion and atten­tion to dead­lines, you can increase your chances of a suc­cess­ful appeal.

Additional Questions

1. Com­mon rea­sons for work­ers’ comp claim denial
2. Lack of med­ical evi­dence in work­ers’ comp claims
3. Appeal­ing a denied work­ers’ comp claim
4. Pre-exist­ing con­di­tions in work­ers’ comp claims
5. Work­ers’ com­pen­sa­tion deadlines

Related Readings:

1. Under­stand­ing Work­ers’ Com­pen­sa­tion Insurance
2. How to Report a Work­place Injury
3. The Impor­tance of Med­ical Evi­dence in Work­ers’ Comp Claims
4. What to Expect Dur­ing a Work­ers’ Comp Appeal Hearing
5. The Role of an Attor­ney in Work­ers’ Comp Claims