3 common reasons workers’ compensation claims get denied

On Behalf of | Aug 28, 2023 | Workers' Compensation |

Workplace injuries can have a significant impact on employees, both physically and financially.

Employees injured on the job often rely on workers’ compensation benefits to cover medical expenses and lost wages. However, not all claims get approved. Understanding the reasons behind denied claims can help employees take necessary precautions and avoid potential pitfalls.

1. Delayed reporting of injury

One primary reason for the denial of workers’ compensation claims is the delayed reporting of injuries. Timely reporting enables employers to investigate the incident with fresh details, preventing potential disputes over the cause and severity of the injury.

2. Lack of medical evidence

Considering that 4.9 million workers’ compensation claims get filed every year, filling out everything correctly and providing all the necessary documentation is vital. When filing a workers’ compensation claim, you must provide medical records that clearly document the injury and its connection to the workplace. Incomplete or vague medical documentation can lead to skepticism about the claim’s validity.

3. Failure to follow proper procedures

Employers often have established protocols for reporting workplace injuries and seeking medical treatment. Failure to adhere to these procedures can result in claim denials. Employees need to follow the correct steps when reporting an injury, such as informing a supervisor, seeking medical attention from approved providers and completing any necessary forms.

Additionally, not adhering to medical advice can also jeopardize a claim. If a doctor recommends specific treatments or work restrictions and the employee fails to follow through, insurers may argue about the injury’s severity or claim the employee is not cooperating in their own recovery.

By being vigilant and adhering to these guidelines, employees can better navigate the workers’ compensation process and ensure they receive the benefits they rightfully deserve.

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