What To Do When Your Workers’ Compensation Claim Is Denied

If you have been injured on the job and have taken the time to go through the process of obtaining workers' compensation, you may find yourself completely shocked to learn that your workers' compensation claim was denied. Even though you are absolutely certain that your injuries were caused because of something that happened on the job, you could still find yourself with a denial. When this happens, it's best to call a workers' compensation lawyer in order to assist you with the appeals process. Here is an overview on why your claim may have been denied, and what you can do next.

Reasons Your Workers' Compensation May Be Denied

There are many reasons why the workers' compensation insurance will deny a claim. Some may be a simple reason that can be easily rectified, while others may be more complex. Generally, workers' compensation claims are denied due to the following reasons:

  • You have no witnesses to your injury 
  • You failed to immediately report your injury 
  • Discrepancies were found on the accident report and medical records 
  • You filed the report after you were laid-off or fired

Your claim may also be denied because you failed to provide simple medical proof of your injury, or a doctor neglected to provide a statement that backed up your claim of the seriousness of your injury. 

The Appeals Process

When you've received a denial for workers' compensation, you'll want to take the next step and have that denial appealed. The first thing you may want to do is contact your workers' compensation insurance carrier to discuss the denial. If the reason was simply because of paperwork that was incomplete or not filed, you may be able to quickly rectify that situation. 

If the reason was more complex, you'll need to speak with a workers' compensation lawyer like Leif D. Erickson regarding the appeals process, because it varies from state to state. Generally, the first level of appeal is a hearing before a law judge. This judge is appointed by the workers' compensation board and is a neutral party. They will review the evidence provided and determine if the denial was justified or not. 

If you are unsuccessful with the administrative judge, the next step will be an appeals hearing, where you will be required to attend and present evidence, just as you would in a regular court trial. Your lawyer may call on expert medical witnesses, as well as the individuals who may have been present at the time of your injury, to provide proof as to why your claim's denial should be reversed.