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Common reasons workers’ comp claims get denied

On Behalf of | May 1, 2024 | Workplace Risks

Workers’ compensation benefits are supposed to be there for you when you have a work-related injury – but getting a claim approved isn’t always as easy as it should be. 

Denied claims are not just frustrating – they can put your health in danger by delaying or disrupting necessary medical care, and they can make it harder for you to keep your finances stable. So, why do workers’ comp claims end up denied? 

1. You didn’t report the injury promptly

You technically have 30 days to provide your employer with written notice of your injury – but you never want to wait that long. It might be understandable if you injured your back and didn’t report it until the next morning after you realized that a couple of ibuprofen and a heating pad wouldn’t fix things – but the longer you wait before informing your employer, the more opportunity there is to allege that your injury wasn’t work-related.

2. Your injury isn’t clearly connected to your work 

One of the main ways that insurers fight workers’ comp claims is by alleging that injuries are not, in fact, employment-related. For example, they may allege that your carpal tunnel syndrome is related to your hobbies, not your job – or that the car accident you had while running errands for your boss was actually “on your own time,” and ineligible for coverage. That makes it very important to tie your injuries directly to your job duties when you’re talking to doctors.

3. You have a pre-existing condition

Insurance companies sometimes look pretty hard into an injured worker’s medical background, and they’ll deny claims based on the idea that a worker’s “pre-existing” condition is the real cause of their medical problems. However, it’s important to know that work-related aggravation or exacerbation of a pre-existing condition is still a coverable injury.

If your initial workers’ compensation claim was denied, seeking legal guidance can help you mount a successful appeal.