Common Reasons Workers' Compensation Is Denied

Posted By Katz Leidman Grossman Wolfe & Freund || 24-Nov-2014

Just because a person may have been injured on the job does not mean that they will successfully file and receive workers' compensation. Some of the reasons a claim is denied may be due to timing or technical conflicts, or for other concerns the court had regarding the claim. Knowing more about compensation claims can help your case.

Why was my workers' compensation claim denied?

If you want to increase the likelihood of your workers' compensation claim's acceptance, you need to know what to avoid; understanding why claims are denied is crucial. Knowing this before taking an employer to court for an injury can help increase the chances that the compensation claim will be accepted.

Some of the main reasons why workers' compensation claims are denied is:

  • The accident was not witnessed by anybody else
  • The injury was not reported to a supervisor within a short period of time
  • The accident report differs from the medical report on the injury
  • The medical report indicates that the person was under the influence of drugs or alcohol
  • The compensation claim was filed after the employee was fired or laid off
  • A recorded statement or medical authorizations were not given to the insurance company

While a person is not legally required to submit a recorded statement or give an insurance company authorization to obtain medical records, a person does have to give the insurance company a copy of their medical records. A person should take action to retrieve and hand over the records themselves to avoid giving an insurer full access to other medical records.

If a claim is denied, there could be an appeal. An appeal would involve a hearing before a judge detailing the case and presenting any medical and factual evidence supporting the claim. The more evidence that can be provided at the hearing, the better the likelihood that the claim denial can be overturned.

Filing for workers' compensation is best done with the assistance of an attorney. A lawyer can help deal with the employer's insurance company that may put undue pressure to obtain a recorded statement or medical authorizations, and can assist in creating the best possible scenario for an appeal.

Categories: Workers' Compensation