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Why was your workers’ compensation claim denied?

On Behalf of | Oct 15, 2017 | Firm News |

As a member of the California workforce, you might have found comfort in knowing that the workers’ compensation insurance system will have your back in the unfortunate event of an on-the-job accident. However, when after the unfortunate incident, your benefits claim was rejected. Now, you are unsure of why this happened and how you will cope with mounting medical bills and other financial obligations due to your inability to return to work for a considerable time.

You may have the right to appeal the denial of your claim, but this is where the process can become complicated. There will be a deadline by which time you must file your appeal, and then the process will involve multiple administrative and legal procedures.

Possible reasons for rejected workers’ compensation claims

Before taking any steps to file an appeal, you must determine and understand why the insurer denied your benefits claim. The denial letter may give you an indication. It could be a simple misunderstanding or some information that you failed to include when you filed your claim. Although there are many reasons for rejected claims, the following are the most common ones:

  • Late reporting — You must report your injury to your employer within a set time. Doing it in writing and keeping a copy might help in the event of an employer trying to prevent paying your benefits.
  • Missed deadline — Your employer must provide you with the necessary forms to fill out, and he or she must then file your claim with the insurance provider within a particular period.
  • Employer dispute — Your employer may disqualify your benefits claim if he or she believes that your injury happened when you were not on duty or while you were fooling around on your own accord.
  • Doubts about your claim being work related — Some injury types can be challenging to prove to be work related. These often include injuries that are stress related or an occupational disease caused by conditions in the workplace. For this reason, medical evaluations as soon as an injury or illness becomes evident are essential because medical evidence may help to support your claim.
  • No medical bills — If you have no medical bills to attach to your claim, there will be no compensation because workers’ compensation benefits cover medical expenses.
  • Non-compensable injury — Your employer may claim that your injury is not a type covered by workers’ compensation. While stress-related injuries may often be questioned, the California workers’ compensation system does cover them.

These are but some of the possible reasons for denial of workers’ compensation benefits claims, and filing an appeal may be something you might want to tackle with experienced legal counsel in your corner. An experienced workers’ compensation attorney can increase your odds of securing the compensation you deserve to maintain financial security during your recuperation.


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