Top 5 Reasons Workers’ Comp Claims Get Denied

Workers’ compensation, often called “workers’ comp,” is a type of insurance that offers benefits to employees who get injured or become ill due while working. This insurance covers medical expenses, lost wages and rehabilitation costs. Workers’ comp is essential because it helps protect workers from financial hardship after a work-related injury, even if they accidentally cause their own injury. However, insurers do not always approve claims. In fact, about 7% of all workers’ compensation claims are initially denied.

5 common reasons for denials

Understanding why workers’ comp claims denials happen can help you avoid these common pitfalls. Here are the top five reasons:

1. Incomplete or inaccurate claim forms : One of the most common reasons for denial is submitting forms that are incomplete or contain errors. Even small mistakes can lead to a rejected claim.
2. Failure to report the injury on time : It’s crucial to report your injury to your employer as soon as possible. Failure to report the injury to an employer within 90 days from the date of the injury jeopardizes the claim’s approval.
3. Lack of medical evidence : It’s challenging to prove that the injury is work-related without proper medical documentation. Ensure you get a thorough medical evaluation and keep all records.
4. Injury not work-related : The insurance company will likely deny the claim if the injury didn’t happen while performing job duties. It’s essential to clearly document how the injury occurred at work.
5. Missed filing deadlines : Workers have two years from the date of injury to report it to the Workers’ Compensation Commission. Missing this deadline can result in an automatic denial.

Understanding these common pitfalls can improve your chances of a successful claim.

How an attorney can help

Navigating the workers’ compensation process can be complex and overwhelming. This is where an attorney can be invaluable. An experienced workers’ comp attorney can help you with the initial filing process, ensuring all paperwork is accurate and submitted on time. They can also help gather necessary medical evidence and represent you in disputes with the insurance company. An attorney can also assist with the appeals process. Remember, help is available, so you don’t have to navigate this process alone.