What to Do When Your Workers' Comp Claim Is Denied
Learn the most common reasons for workers comp claim denials and the steps to successfully appeal.
Having your workers' compensation claim denied can be frightening, especially when you are injured and unable to work. However, a denial is not the end of the road. Many denied claims are overturned on appeal when the worker obtains proper legal representation and presents additional medical evidence or legal arguments that address the basis for denial.
Common Denial Reasons
Workers' compensation claims are most frequently denied because the insurer disputes that the injury is work-related, the injury was not reported within the required timeframe, the employer disputes the circumstances of the injury, the medical evidence does not support the claimed condition, the injury involves a pre-existing condition, or the worker missed a medical appointment or refused treatment. Understanding the specific reason for your denial is essential because each requires a different response strategy.
The appeal process begins by filing a petition or request for hearing with your state's workers' compensation board. This initiates an administrative proceeding where both sides present evidence and testimony. Independent medical examinations, witness statements, employment records, and expert testimony may all be relevant. An experienced workers' compensation attorney can analyze the denial, identify the strongest arguments for overturning it, and guide you through the hearing process. Most workers' compensation attorneys work on contingency, so you typically pay nothing unless you win your appeal.