4 Common Reasons for Workers’ Compensation Claim Denials

Be sure to report promptly, gather proper medical documentation, and seek legal assistance to increase the chances of a successful claim.

If you recently suffered a job-related illness or injury, you are eligible for workers’ compensation to help cover medical bills and lost wages. However, before filing a claim, it is crucial to understand not all claims are approved. In this article, we’ll highlight four common reasons for workers’ compensation claim denials to help you avoid mistakes and increase your chances of receiving the benefits you deserve.

1. Employer disputes the claim

Sometimes, an employer may challenge your workers’ compensation claim. They may argue that your injury or illness was pre-existing, occurred due to your negligence, or was not as severe as reported. When this happens, consider seeking legal assistance. A Charlotte workers’ compensation lawyer can help you gather evidence, obtain witness testimonies, and counter your employer’s disputes to improve your chances of a successful claim. Here’s what to consider when choosing the right attorney for your case:

• Experience in workers’ compensation cases: Look for an attorney specializing in workers’ compensation law who has a proven track record of handling similar cases successfully. Experience in dealing with employer disputes and insurance companies is crucial.
• The success rate in disputed claims: Since employer disputes can complicate claims, ask about the attorney’s experience handling cases where the employer denied or challenged the claim. 
• Knowledge of local laws: Workers’ compensation laws vary by state, so it’s essential to choose an attorney familiar with the specific regulations in your area.
• Resources and legal team: A well-established law firm with access to medical experts, vocational specialists, and investigators can strengthen your case by providing credible evidence and expert testimony.

2. Failure to report the injury on time

One of the most common reasons for a workers’ compensation denial is failing to report the injury within the required time frame. Every state has specific deadlines for reporting workplace injuries. Missing the deadline can result in automatic denial. The insurance company or employer may argue that a delay in reporting raises doubt about the legitimacy of your claim. To avoid such allegations, notify your employer as soon as an injury occurs and document the report in writing.

3. Lack of medical evidence

   

The success of your workers’ compensation claim often lies in solid medical evidence. Your claim may be denied if you do not seek medical attention immediately after an injury or fail to follow up on prescribed treatments. The insurance company often looks for consistent medical records that confirm the severity and cause of your injuries. Be sure to visit a doctor promptly, follow all medical advice, and maintain detailed medical records to strengthen your claim.

4. The injury did not happen at work 

Workers’ compensation covers only job-related injuries. If your employer or insurer believes the injury occurred outside work, they may deny the claim. Discrepancies in the injury report, lack of witnesses, or inconsistent medical records can result in claim denials. Before filing your claim, ensure your report is accurate and provide any available evidence, including security footage, witness statements, or medical records linking the injury to workplace activities.

Endnote

A workers’ compensation claim denial can leave you without the financial support you need. Be sure to report promptly, gather proper medical documentation, and seek legal assistance to increase the chances of a successful claim.