Committed To Our Clients And Community
  1. Home
  2.  – 
  3. Injuries
  4.  – 4 common causes of workers’ compensation claim denials

4 common causes of workers’ compensation claim denials

On Behalf of | Jun 3, 2024 | Injuries |

Workers’ compensation can help employees recover from their injuries by providing injured workers with medical coverage and lost wages — among other critical benefits.

When an injured employee files for workers’ comp benefits, however, they may be surprised that their claim was abruptly denied. To launch a successful appeal, it helps to understand the basis for the denial. Many denials happen for the following reasons: 

1. Additional paperwork is needed

Filing a successful workers’ comp claim often requires lots of paperwork, such as an incident report and medical records. If any documentation is missing, a workers’ comp claim could be denied. Missing paperwork is a frequent issue that can often be resolved easily.

2. A deadline was missed

An injured worker has several deadlines they must meet to file for workers’ comp. Workers must report their injuries within 30 days from their injuries to their employer or manager. The injured worker has two years to file for workers’ comp benefits. The sooner a worker files for these benefits, the more likely they are to receive these benefits. Missing any of these statutes of limitations can lead to a denial.

3. The injury is not severe enough

Not every injury is eligible for workers comp benefits. Brain or spine injury may lead to long-term disabilities. However, minor injuries, such as cuts and bruises may not limit an employee’s ability to work. However, a worker and the workers’ comp insurer may disagree about exactly how severe an injury really is — and that may lead to a battle over benefits.

4. The injury did not happen at work

One of the main requirements for a worker to file for workers’ comp benefits is that the injury must have happened while they were working. Unfortunately, if an accident wasn’t witnessed or a worker develops a repetitive strain injury that slowly developed over time, they may find their claims unfairly denied on the basis that they’re “not work-related.”

If your workers’ comp claim was denied, it can help to reach out for legal assisance to learn what options you have to appeal.