Tried And True Attorneys Standing Up For The Injured Since 1965

Photo of Craig R. Fishman
Photo of Craig R. Fishman

Tried And True Attorneys Standing Up For The Injured Since 1965

Five reasons why a workers’ compensation claim can be denied

On Behalf of | Mar 28, 2024 | Workers' Compensation |

A workplace injury can knock you off the job and leave you struggling to pay your medical bills, cover your rent, and keep food on the table. You don’t deserve that kind of struggle. Fortunately, you won’t have to face those difficulties if you can secure workers’ compensation benefits. This financial lifeline can help offset your expenses while you focus on your recovery and getting back to work, putting your mind at ease in a tough time.

Yet, these benefits aren’t freely handed out. In fact, many workers’ compensation claims are denied. And those who are cut off from the benefits they need can face financial ruin if they’re out of options for support. That’s why it’s critical that you understand some of the reasons why these claims are denied. If you know what the insurance company is looking for to deny your claim, then you can develop strategies to counter them and increase your chances of recovering the benefits you need and deserve.

Reasons why workers’ compensation claims are denied

There are several reasons why workers’ compensation claims are denied. Let’s look at some of them here:

  • Your injury wasn’t suffered at work: To qualify for workers’ compensation benefits, you have to show that your injuries were suffered at work. If you admit to being hurt when off the job, then you’ll be denied benefits.
  • You had a pre-existing condition: You can recover workers’ compensation benefits if a pre-existing condition was exacerbated by your work duties, but in many instances the insurance company will try to latch onto that pre-existing condition to try to show that your harm wasn’t suffered at work. So, be sure to have clear documentation from your doctor about your injury and how it could’ve been made worse at work.
  • Your injuries aren’t as severe as you claim them to be: Remember, workers’ compensation benefits are meant to support you and your recovery when you’re unable to work because of the harm you’ve suffered. If your injuries don’t prevent you from working, then your claim will be denied. Be sure to have medical evidence showing the extent and severity of your injuries and behave in line with those injuries. In other words, don’t overdo it and make yourself look like you’re less hurt than you really are.
  • You didn’t seek medical treatment: You need evidence to show that you qualify for workers’ compensation benefits. But if you don’t seek treatment for your injuries, then you’re not going to have the medical documentation you need to support your claim. Seek out immediate medical attention after you’ve been injured and be sure to follow your doctor’s recommendations.
  • You don’t comply with the insurance company’s requests: You don’t have to do everything the insurance company asks of you, but there are certain steps in the process that require compliance. For example, if you refuse to appear for an independent medical examination, then your workers’ compensation claim will likely be denied.

Avoid costly errors that could lead to a workers’ compensation claim denial

There’s simply too much on the line in your workers’ compensation case to put forth anything less than your best effort. You should understand the law and how it applies to your set of circumstances, and you need to anticipate how the insurance company is going to respond to your claim. If you put in thoughtful preparation and gather relevant evidence, then you can decrease the chances that your claim will be denied. Hopefully then you’ll gain access to the resources you need to focus on your recovery and find financial security.