Why Work Injury Claims Are Denied, And How To Avoid A Denial

The workers’ compensation system is designed to protect employees who are injured on the job, but that doesn’t mean that workers’ compensation insurance providers just approve every claim that comes across their desk. Insurance adjusters will do everything in their power to come up with a valid reason to reduce or even outright deny your claim, so it’s important that you understand some of the most common reasons for denial so that you can prepare your claim accordingly. In today’s blog, we explore some of the most common reasons that injury claims are denied, and how to take steps to avoid a denial.

Why Are Work Comp Claims Rejected?

Your employer’s workers’ compensation provider may opt not to accept your claim for a number of reasons, but here’s a look at some of the most common reasons that insurance companies have for legally rejecting a claim:

Failure To Report In A Timely Manner – You need to report your work injury to your employer in a prompt manner. If you wait weeks or months to report the injury, the insurance company may argue that you actually suffered the injury off the clock or that your symptoms are not the result of work activities. Don’t give them any reason to doubt the legitimacy of your claim.

Didn’t Get A Medical Evaluation – It’s not enough to say that your neck hurts after an accident, you need to have your injuries professionally documented by a healthcare specialist. If you haven’t yet visited a doctor, don’t expect your claim to be approved.

Missed Deadlines – Although you have a fair amount of time to file most injury claims, there are time constraints that you’ll need to meet. If you wait years to file an injury claim, it’s possible that you missed your window to collect compensation.

Incomplete Paperwork – You’ll need to fill out a few different forms in order to earn compensation for an on-the-job injury. If you miss a form or you don’t fill the paperwork out properly, the insurance company may deny your claim until these issues are corrected.

Non-Compensable Injury – It’s possible that the insurance company denies your claim because they believe that your injuries are not work related or not actually a compensable injury. For example, if they believe your carpal tunnel is tied to normal degeneration instead of work-related activities, or if they argue that you were injured while on an unpaid break, they may claim that you are not entitled to benefits.

Discrepancies – The insurance company may deny your claim if there are discrepancies in the injury reports. If you say the injury happened in one way, but your employer or video evidence suggests it happened in a different manner, the insurance company may deny the claim until the facts are sorted out.

We touched on some of the ways you can avoid the above denials in each section, but the single best thing you can do if you want to avoid a claim denial is to connect with a workers’ compensation lawyer. A lawyer will have decades of experience building airtight claims that stand up to common reasons for denial, and they’ll also ensure that some of the clerical reasons for denial are appropriately managed. You won’t have to worry about missed deadlines or incomplete forms if you let a lawyer build your claim for you. We’ve helped countless clients avoid claim denials, and we’ll do the same for you.

We can also help in the event that your claim is denied. Claim denials are common, but that should not stop you from pursuing the compensation you deserve. Let us review your reason for denial and resubmit an amended claim or prepare to make your case in front of a judge. We won’t stop until you get the compensation you deserve.

For more information, or for help with a different issue, reach out to Dean and the team at Margolis Law Firm today at (952) 230-2700.