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4 reasons why a workers’ compensation claim might be denied

On Behalf of | Jan 10, 2022 | Denied Claims, Workers' Compensation |

Injuries in the workplace are common in nearly every occupation. While certain occupations are more at risk for accidents, almost every shift in any career carries some level of potential injury. After a work-related injury, however, many individuals are hesitant to file a workers’ compensation claim. The reasons for this can include the fear of retaliation or the assumption the claim will get denied.

It is not uncommon for officials to deny a workers’ compensation claim at the initial stage. While every case is unique, there are certain common reasons for denial, including:

  • Procedural errors: After a work accident, it is not uncommon for the injured individual to feel flustered at the process itself. Unfortunately, mistakes in documentation, information errors and missed deadlines can all potentially lead to a delayed or denied workers’ compensation claim.
  • The employer disputes the claim: While this does not always happen, the employer could claim the injury is not work-related. The employer might claim the injury initially happened outside of work or was the result of horseplay or gross negligence.
  • The employee fails to provide sufficient evidence: Like the previous item, to ensure the strength of the claim, the worker must provide sufficient evidence that the injury happened at work. If the claim is denied on this basis, the employee could seek another medical exam or provide additional evidence.
  • The injury is deemed non-compensable: While it might seem obvious to the worker that the accident occurred while on the job and the injury is covered by workers’ compensation, the governing body might disagree. Certain injuries, such as those related to work stress, can be difficult to prove and might require additional information and medical statements.

Fortunately for many injured workers, a denial isn’t always the final answer. The claim process has the potential for an appeal built directly into the procedure. A successful workers’ compensation benefits appeal might require additional documentation, supplemental information or a clarification of the original data. It is wise to seek the guidance of an experienced workers’ compensation attorney as the appeals process will likely hinge on complex facts and dense medical information.