Why Are Workers’ Compensation Claims Denied?

You can be denied workers’ compensation benefits for numerous reasons. There are legitimate claims that are denied every year. Here are some of the more common reasons that workers’ comp claims are denied, and what can be done to get your claim approved and recover the benefits that you need to help you after your workplace injury.

Your Workplace Injury or Illness Wasn’t Properly Reported

When you get sick or hurt because of your job, you must notify your employer right away. Often, you will need to fill out forms in detail. If you do not follow proper procedures, your claim can be denied. Many states have specific deadlines for reporting a work-related illness or injury. Familiarize yourself with the state laws regarding workers’ comp where you work and be sure to ask questions if you are unsure of specific rules or regulations.

Your Condition Is Pre-Existing or Was Not Caused by Work

If you have a pre-existing medical condition that was not caused by a workplace injury, then you will not qualify for workers’ compensation. You must prove that your injury or illness was a direct result of your job. You will need supporting evidence and documentation, such as witness statements, photos, video footage, and so forth to confirm that your medical issue resulted from the workplace. Be sure to tell the treating physician that you suffered your injury on the job, so it can be documented.

You Require Out-of-Network Care

If you get medical care that is out-of-network then it is not covered by your employers’ workers’ compensation insurance, then your claim could be denied. Most employers have a list of in-network medical providers for workplace injuries and illnesses. That means you must see a provider on that list. Your employer should provide you with a list of in-network providers, and you should seek treatment from providers on that list.

Deadlines Were Missed

There are deadlines in place for how long you have so you can report an injury, there are deadlines for filing a claim, deadlines for submitting specific paperwork, and so forth. Be sure that you are familiar with your state laws and that you do not miss any deadlines. Missing a deadline can lead to a denied claim or the loss of workers’ compensation benefits. Be sure to maintain detailed documentation, and report everything as soon as possible. Time is of the essence with your workers’ comp claim.

You Didn’t Seek Legal Help

A workers’ compensation lawyer can help you with your claim. Workers’ comp lawyers are familiar with the applicable state laws. Your lawyer can help you ensure all paperwork is filed on time and that proper protocol are followed throughout the claims process. Complete the Free Case Evaluation Form to get connected with an independent, participating attorney who subscribes to the website.

Additional Resources

• Were You Denied Workers' Compensation?
• Workers' Compensation Denial By State