How to deal with a workers’ compensation claim denial

On Behalf of | Apr 11, 2023 | Blog, Workers' Compensation |

If you receive an injury on the job, workers’ compensation insurance often covers medical care, lost wages and disability benefits. Unfortunately, it is common to receive a denial after filing a claim.

There are various reasons an employer or insurance company denies workers’ compensation claims. If you think your denial was due to a clerical error or other insignificant reason, you may choose to appeal the decision.

Common reasons for denial

According to Insurance Business, missed deadlines are common reasons for a denial. There is a tight deadline for filing a claim, so informing your employer about the injury right away is crucial. Another reason for denial is that the injury did not occur at work. Even if there is evidence the injury is work-related, workers’ comp does not cover injuries caused by alcohol or drug use, horseplay or self-infliction.

To receive workers’ compensation benefits, the injured worker must seek medical treatment for injuries, so a common reason for denial is if the worker did not attend appointments or sought care with an out-of-network provider.

Appeals process

The denial letter you receive may state the reason for the denial, or you can call the insurance company and ask. If you feel you still have a valid claim, you can file an appeal. FindLaw states that the letter will also give a deadline for this, as well as directions on where/how to file it. When fighting your denial, it helps to present any evidence that supports your case. This may include medical records, a time sheet proving you were at work the day of the injury or witness testimonies.

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