Workers Comp Claim Denied? Here's What to Do Next

Having your workers compensation claim denied is stressful, especially when you are dealing with injuries and unable to work. However, a denial is not the final word. Many denied claims are successfully overturned on appeal. Understanding why your claim was denied and how to appeal is essential.

Common Reasons for Denial

The employer disputes that the injury occurred at work. The insurance company argues the injury is not work-related. You failed to report the injury to your employer within the required timeframe. You did not seek medical treatment promptly. The insurance company claims you had a pre-existing condition. You missed the filing deadline for your workers comp claim. The employer argues you were under the influence of drugs or alcohol at the time of the injury. The insurance company's doctor disagrees with your treating physician's diagnosis.

Step 1: Understand the Denial

Request a written explanation of the denial. Review the specific reasons cited and gather evidence to address each one. Understand the appeal deadlines in your state, as they are often short.

Step 2: Gather Additional Evidence

Obtain additional medical records and opinions supporting your claim. Get statements from coworkers who witnessed the injury or can confirm your job duties. Document your work activities and how they relate to your injury. Request a second medical opinion if the denial was based on an IME.

Step 3: File an Appeal

File a formal appeal with your state's workers compensation board within the required deadline. Include all supporting documentation and a clear explanation of why the denial should be overturned. Consider hiring a workers compensation attorney to represent you at the hearing.

Step 4: Attend the Hearing

Most workers comp appeals involve a hearing before an administrative law judge. Present your evidence, testimony, and medical records. Your attorney can cross-examine the insurance company's witnesses and challenge their evidence.

Conclusion

A denied workers comp claim can be overturned with the right evidence and legal strategy. Do not give up. File your appeal promptly and consider hiring an attorney.

Use our free settlement calculator to estimate what your workers comp case might be worth.