Certified Workers’ Compensation Specialist*

Certified Workers’ Compensation Specialist*

Why would a workers’ compensation claim get denied?

Employees who sustain injuries in the course of fulfilling their job duties typically file for workers’ compensation benefits. However, not all such claims are granted.

Understanding some of the reasons why workers’ comp claims can get denied can help you avoid common pitfalls and better ensure a smoother process if you ever need to file a claim. 

Common reasons for workers’ comp claim denial

Some reasons why workers’ compensation claims might be denied include:

  • Inaccurate or incomplete documentation: Take time to confirm that all forms and documentation are filled out accurately and completely. Any missing information or inconsistencies can lead to a denial.
  • Delayed reporting: Promptly report any workplace injuries to your employer. Delayed reporting may raise doubts about the legitimacy of your claim.
  • Pre-existing conditions: If your injury is related to a pre-existing condition or medical issue, it can complicate your claim. Be transparent about your medical history and how it relates to the current injury.
  • Failure to seek medical treatment: Neglecting to seek timely medical treatment for your injury can be used as grounds for denial. Always seek medical attention as soon as possible after an injury occurs.
  • Disputes over causation: If there is uncertainty about whether your injury occurred at work or was caused by work-related activities, your claim may be denied. Provide clear evidence linking the injury to your job duties.
  • Non-work related activities: If your injury occurred while engaging in non-work-related activities or violating workplace policies, your claim may be denied.
  • Independent medical examinations (IMEs): If the findings of an independent medical examination commissioned by the insurer conflict with your claim, it can result in denial. Be prepared to address any discrepancies.
  • Statute of limitations: Workers’ comp claims must be filed within a specified timeframe after the injury occurs. Missing this deadline can result in denial.

By understanding these potential reasons for denial and seeking legal guidance, it’s possible to navigate the workers’ compensation process more effectively and increase the chances of a successful claim outcome.