What to Do If Your Workers’ Compensation Claim Has Been Denied?

Almost all states require employers to provide workers’ compensation insurance to their employees. This ensures that workers are covered in the unfortunate event of an injury at the workplace. But what should one do if their workers’ compensation claim is denied? Luckily, the worker still has a number of options they can turn to, including an appeal through their state’s board of workers’ compensation.

However, the success of this appeal will depend on a number of reasons, the most important of all being why the claim was denied in the first place. Read on to understand the steps one can take if their workers’ compensation claim was denied. Although the laws vary from state to state, you may still be eligible to file an appeal. Get in touch with a workers’ compensation claim attorney immediately.

Identify the cause of denial

If your workers’ compensation claim was denied, the first thing to do is to determine the reason for denial. The reason should be explained in the denial letter. One of the most common reasons for denial includes not meeting the eligibility requirements. For example, you could have been injured when you were away from work or when you were engaged in “horseplay.” Discussing your case with an attorney can make you better understand if the denial was valid or was reached in error.

A list of some of the common reasons for denial of workers’ compensation benefits is given below:

You did not report the injury on time – Injuries typically have to be reported within a few days to the employer in writing.

You did not file the claim in time – Most states require the initial workers’ compensation claim to be filed within 30 to 90 days of the injury.

Your employer disputes the claim – The employer may have reason to disqualify the claim, for example if the injury or accident happened outside of work or when you were engaged in horseplay.

Your injury is not compensable – Some injuries are hard to prove. Examples of such injuries are stress-related injuries. Also, not all states cover stress-related injuries.

You did not seek medical treatment – Medical treatment must be sought in order to receive workers’ comp benefits. If the injury was a minor one which did not require medical assistance, or if you were negligent and did not seek the required assistance at the right time, leading to further complications, then you will not be eligible for workers’ comp benefits.

Not enough evidence to prove the injury is work related – In cases where it is not clear whether the injury was work related or not, getting a medical exam may help prove your case.

Apart from the above listed reasons, there may be other reasons for the denial of your workers’ comp claim. In case your claim has been denied, you may want to appeal the decision.

Appealing a denied workers’ comp claim

When you receive the denial letter, the reason for denial along with a deadline for filing an appeal is mentioned on it. However, before filing the appeal, discuss the issue with your employer in order to resolve any disputes or misunderstandings.

Appealing the decision can be a long and complicated legal process, therefore, getting help from an experienced and qualified workers’ comp attorney is advised.