There can be multiple reasons why your workers’ comp claim was denied. The process of approval is complex, but a denied workers’ comp claim can be appealed through proper evidence and the help of a skilled attorney.
Below are the top five common reasons why a workers’ comp claim is denied, but legal advice specific to your case requires a free consultation with a lawyer. Getting denied is not the end, as about 7% of all workers’ comp claims get denied, but get reversed later down the line. Companies don’t want to pay out for injuries, but to get your entitled compensation, you need a trusted attorney in your corner.
Top 5 Reasons Why Your Workers’ Comp Claim Was Denied
1. Insufficient Evidence
You must obtain medical treatment for your work-related injuries to prove eligibility for workers’ compensation benefits. Discuss every symptom of the injury with the doctor, whether they seem severe or not. Get a copy of your medical records for your attorney to look over. If you don’t have medical documents, the insurance company can deny your claim for lack of evidence.
2. Disputes About Whether the Injury Was Work-Related
Your employer may claim the following to avoid compensating you for your injury:
- The accident happened outside of work
- Your injuries were the result of your misconduct or negligence
- Injuries you suffered were not the result of work
To support your claim, you’ll need to gather evidence, witness accounts, and medical documents to prove your injury is work-related and wasn’t your fault. If you were injured while waiting tables at a restaurant, you may qualify for a claim. If you were injured during lunch break or another location, proving whether your injury was work-related is much harder.
3. The Injury Isn’t Compensable
Sometimes, insurance companies claim your injuries aren’t severe enough to meet the requirements for a workers’ compensation claim. Besides, claims for trauma, psychological conditions, and stress-related injuries are often difficult to prove. In fact, some states rule out claims for illnesses caused by long-term emotional stress at work.
4. Not Filing the Paperwork On Time
You must report the workplace injury on time to your supervisor. States have different time limits for reporting injuries. For instance, Colorado law requires employers to be notified in writing within four days. Then, you must typically file an initial claim within 30 to 90 days, depending on the state law. If you fail to meet these state-specific deadlines, your workers’ compensation claim can be denied.
5. Claim Was Filed After Leaving the Job
If you file the claim after being laid off, fired, or quit your job, your insurance company may deny the claim. This can be the case when injured while serving your notice period, or maybe you were illegally fired in retaliation for reporting a workplace injury. Some states have special rules for claims filed after you left your job. If you qualify for one of the exceptions in your state’s law, you may be able to contest the denial.
How to Appeal If Your Workers’ Comp Claim Was Denied
Based on the justification given by the insurance company in the denial letter, you can request they reconsider their decision by providing additional evidence and supporting documents. If you’re unable to settle the matter in your favor, you can file a formal appeal. There are strict deadlines for appealing denials, which vary from state to state. Look for your state’s deadline on the denial letter, and file an appeal on time.
Why Do I Need a Workers’ Comp Attorney?
If you’re injured on the job, you may ask yourself “Do I need a lawyer?” The formal procedure for filing an initial claim or appeal is complex and varies state by state. Hiring a workers’ compensation attorney will help you navigate the complex steps and seek your potentially deserved compensation. Expert legal representation will let you put forward the most persuasive case possible.
With LegalASAP, you can receive a workers’ compensation evaluation for free. All you need to do is fill out the form on our website and we can provide you with a free evaluation. The specialized workers compensation lawyers in our network will connect with you to make sure your claim is represented. Contact us today if you have any questions or concerns.
Jan Reburiano is a content writer and SEO specialist for law firms focusing on personal injury, disability, employment law, among other practices. He has written and edited numerous articles and created commercial spots for broadcasters that you can find in his LinkedIn. Jan currently lives in Los Angeles, California while writing for clients from around the United States.