Common Reasons for Workers' Compensation Claim Denials

After a workplace injury, you need your disability benefits to pay your bills. It can take weeks before you start getting workers’ comp benefits. If your employer denies your claim, it can take even longer. If you get notice of a denial, you can request a hearing or file an appeal. But getting the application right the first time can help you avoid delays.

Workers’ compensation laws differ depending on where you live. For more information about your workers’ compensation claim denial, talk to a local workers’ compensation lawyer for legal advice.

Why Are Workers’ Comp Claims Denied?

The workers’ compensation system provides wage and medical care benefits to help injured workers get by until they can get back to work. State law requires most employers to carry workers’ compensation insurance. After a work-related accident, employees report the injury to their employer, get medical care, and file a claim with the state Board of Workers’ Compensation.

Employers and the workers’ comp insurance company can challenge or deny workers’ comp claims. The insurance company can deny your workers’ comp claim because they don’t want to pay your medical bills or disability benefits. If the insurance provider can find a reason, they will deny benefits for your work-related injuries.

There are many reasons to deny a workers’ comp claim. Some of the most common reasons for denied workers’ compensation claims include:

• Administrative errors
• The claim wasn’t submitted on time
• Discrepancies in the injury report
• No medical documentation submitted
• The injury is from a pre-existing condition
• The employee never reported the workplace incident
• The employee didn’t get medical attention
• The employee didn’t follow their doctor’s instructions
• The employee intentionally caused the workplace accident
• The employee was under the influence of alcohol or drugs
• The injured employee can return to work

How Do You Get Approval for Your Workers’ Compensation Claims?

Even minor errors can lead to a denial. Review all the claim requirements before submitting your claim. Make sure you have supporting evidence and follow the filing deadlines. Talking to an experienced lawyer can help you make sure you have everything necessary to get your claim approved.

Workers’ compensation claims have strict requirements. Review the requirements and double-check that you have followed all the instructions. Requirements for workers’ comp include:

• Reporting the accident to your employer
• Getting a medical evaluation
• Filing a workers’ comp claim with the state agency
• Providing supporting evidence of your medical treatment
• Notifying your employer when you can return to light duty or full-time employment

What Evidence Do You Need for a Workers’ Compensation Case?

You need evidence of your medical condition for a workers’ comp claim. Only a medical professional can provide a medical assessment of your injuries and your ability to return to employment. As part of your workers’ comp claim, you need to submit your medical records.

You also need supporting evidence to show it was a work-related injury. Evidence can include:

• Work incident reports
• Police reports
• Photos or videos of the accident scene
• Witness statements from coworkers
• Time cards

Your lawyer can work with your healthcare provider to make sure you have the necessary medical evidence. Your workers’ comp attorney can also review your evidence and make sure you have everything you need for approval.

What Are the Deadlines for Filing Workers’ Comp?

There are strict deadlines for workers’ comp claims. Generally, the most important deadlines include:

• Deadline for reporting the accident to your employer
• Deadline for filing a workers’ comp claim with the state

Every state has different reporting and filing deadlines. The time limit can vary depending on your state law. The time limit to report the accident to your employer ranges from as soon as possible to about 180 days or longer. Any delays in reporting can increase the risk of denial. Report the accident to your employer in writing as soon as you can.

States also have deadlines for filing to get benefits. The workers’ comp claim deadline can range from about 90 days to five years or more. You can avoid filing your claim too late if you contact a lawyer after your accident. Your local workers’ comp lawyer knows the state deadlines. They can make sure you file your claim in time.

Can You Appeal a Workers’ Comp Denial?

If you get a notice that the workers’ comp board denied your claim, you can file an appeal. The dispute process can depend on your state. You can request a hearing, reconsideration, or file an appeal. Some states also have an arbitration process where a neutral arbitrator will make a finding on your claim.

There are deadlines for requesting a hearing or filing a workers’ comp appeal. If you want to challenge your denial, contact a workers’ comp lawyer. They can review your case and identify how you can get your claim approved. Your lawyer can file an appeal and represent you in court hearings.

How a Lawyer Can Help With a Workers’ Comp Claim

The workers’ compensation claims process is not simple. There are plenty of ways you can make a simple mistake that will result in your claim being denied. An experienced lawyer can help you make sure your claim gets approved the first time. For a workers’ comp claim denial, your attorney can get the evidence necessary for approval on reconsideration. Contact a workers’ comp lawyer for help if your workers’ comp claim gets denied.