4 common reasons for a workers’ comp claim denial

On Behalf of | Nov 18, 2023 | Workers' Compensation |

In the realm of workplace injuries, the hope is always that the safety net of workers’ compensation will catch those who find themselves injured on the job.

However, not every claim results in the expected support. Denied claims can be a harsh reality, leaving workers grappling with medical bills and lost wages.

1. Delayed reporting

One of the leading causes of denied workers’ compensation claims is delaying reporting. Employers and insurance providers rely on timely notification to investigate claims effectively. Waiting too long to report an injury may raise suspicions about the legitimacy of the incident.

2. Lack of medical documentation

In the absence of thorough medical documentation, workers’ compensation claims often meet rejection. Incomplete or vague medical records can cast doubt on the severity and cause of an injury. To bolster the chances of a successful claim, individuals should seek immediate medical attention and maintain a detailed record of their diagnosis, treatment plan, and any prescribed medications.

3. Failure to prove work-relatedness

Another stumbling block is the failure to establish a clear connection between the injury and the workplace. To prevent a denial, workers must diligently demonstrate how their injury directly resulted from their job duties. Providing a detailed account of the incident, eyewitness statements if available, and any other relevant evidence can help substantiate the claim.

4. Pre-existing conditions

Workers with pre-existing conditions face additional scrutiny when filing workers’ compensation claims. Insurance providers may attribute injuries to pre-existing conditions rather than workplace incidents. To overcome this hurdle, individuals should be transparent about their pre-existing conditions from the outset.

In 2022, 2.8 million nonfatal workplace injuries and illnesses occurred. Unfortunately, not all workers’ comp claims come with approval. Even if you receive a denial, you still have options to get the compensation you deserve.