Workers’ compensation claim denial reasons

On Behalf of | May 10, 2021 | Workers' Compensation |

Workers’ compensation is intended to provide benefits to injured workers and help replace their income. When an injured employee applies for workers’ compensation and the claim is denied, it can be hard to know what to do next.

Denial reasons

If a workers’ compensation claim is denied, the employee should receive a letter explaining why. There are some common reasons why a claim may be denied that are helpful to understand.

Usually, the employee must report the injury to his or her supervisor timely and if he or she fails to do so, the claim may be denied. Also, if the claim was not filed on time, it may also be denied for that reason.

In most cases, the employee must receive medical treatment in order to receive workers’ compensation benefits. If this was not completed or there is not enough medical evidence to determine that the injury happened at work, the claim may be denied. However, the employee may be able to complete an additional medical exam and/or provide additional evidence to show that the injury is work-related.

Sometimes, employers will dispute claims because they believe the injury happened outside of work due to the employee’s own negligence.

Appeals

Once employees know the reason for the claim denial, they can appeal the decision. The workers’ compensation denial letter should provide a deadline for submitting an appeal. It’s helpful to bring documentation, including medical records or timesheets demonstrating that the employee was working at the time of the injury, for example.

An experienced workers’ compensation attorney can assist employees with their questions and review denied claims to ensure workers receive the compensation they are entitled to.

 

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