3 common reasons for workers’ compensation claim denials

On Behalf of | Oct 23, 2023 | Workers' Compensation |

Workers’ compensation is a safety net for employees who sustain work-related injuries or illnesses. However, claim denials can be a frustrating and distressing experience.

There are several common reasons for workers’ compensation claim denial.

1. Timely reporting violation

One common reason for workers’ compensation claim denials is a timely reporting violation. In Illinois, workers must report an injury to their employer within 45 days. Reporting your injury late can invalidate the claim. Report your injury as soon as possible to reduce this risk, and make sure you document everything along the way.

2. Insufficient medical support

When you report an injury to your employer, part of the workers’ compensation claim process includes medical evaluations of your condition. Failure to seek medical attention can invalidate your claim. In addition, inconsistencies between your initial evaluation and your independent evaluation or subsequent statements might call your claim into question.

3. Pre-existing conditions

A pre-existing condition can complicate workers’ compensation claims. If you receive a denial due to a pre-existing condition, you can appeal if you have evidence that your condition did not contribute to the situation. Historical medical records that detail the condition, its long-term effects and its maximum recovery can help you prove that case.

You can appeal a claim denial and ask for reconsideration of your case. Understanding the basic reasons for that denial might make it easier for you to support your claim during that appeal. Remember that comprehensive documentation and consistent, accurate information are your best forms of evidence to support your claim.

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