What if My Workers’ Comp Claim is Denied?

Legal Tips and Resources

If you are hurt while performing your job or suffering from a repetitive stress injury that occurred because the type of work you do, or even if you acquired a disease as a result of being exposed to toxic chemicals, you will likely qualify for workers’ compensation benefits. What happens when your claim for benefits is not approved?

Workers’ compensation payouts are expenses to companies and insurance companies, and they will look very closely for any conceivable reason to deny your claim. Common causes for your claim being denied may include:

  • Your employer will argue whether or not your injury was indeed related to your job. They could say you weren’t working when the accident happened, or your illness had nothing to do with your job. It will be up to you to put together more evidence supporting your claim. If you have anyone that witnessed the accident, get them to submit a statement. Did you submit the appropriate medical reports? If so, and you were still denied, the insurance company may require you to see another doctor for a second opinion.
  • There are time limits for submitting workers’ compensation claims. Did you report your accident or condition immediately to your employer? Each state imposes different deadlines so be sure to know the laws in your state. In some states, it is your responsibility to file the claim with the states. In other states, the insurance company or your employer will do this step for you once they are aware of your accident. If the deadline is missed, chances are your claim will be denied.
  • Your injury or illness did not meet the guidelines set in your state to qualify for workers’ comp benefits. The rules for psychological or repetitive trauma vary from state to state and some states simply do not cover illnesses that were a result of cumulative emotional stress at work. Or your physical injury isn’t critical enough to meet the standards necessary to be approved for a workers’ comp claim.
  • If you waited until you left your place of employment (whether it be you quit, got laid off, or fired) to file a workers’ comp claim, you may be denied benefits. There may be extenuating circumstances around your departure that caused you to delay in filing a claim, such as you did report the injury while you were working so the claim process had begun, or perhaps you were fired because you reported an injury at your workplace (this is not legal). You can contest your denial if you qualify under one of your state’s exceptions.

What Do I Do If My Claim was Denied?

The letter you receive denying your claim will detail the reason for the denial. Sometimes there was an error in the submitted paperwork and you can contact the insurance claims adjuster to see if the error can be fixed. This is not always successful because that means the insurance provider or your employer will have to admit to making the mistake. Your best chance is to file an appeal using experienced workers’ compensation lawyers.

If you were injured at work and want to make sure you qualify for maximum benefits, remember that there are workers’ compensation lawyers who can help you and provide you with more information, schedule a free consultation with a trusted workers’ compensation lawyer relies on.

Thank you to our contributors at the Law Offices of Franks, Koenig & Neuwelt for their knowledge about workers’ compensation benefits.