When Your Workers' Compensation Claim Is Denied

When you have been injured on the job, you have the right to file a claim with your employer's workers' compensation insurance. This is a legally mandated insurance policy that your employer must have in place on all of their employees. But what is not legally mandated is the acceptance of the claim. If the insurance company feels that the claim is not valid, they can deny it. However, if you feel that the denial is not justified, you can certainly appeal that decision. Here are some reasons behind why your workers' compensation claim may be denied.

Costs for Premiums

When a workers' compensation claim gets filed, your employers premiums may go up. This is especially true if the employee's injury results in an extensive claim. In times like these, insurance companies often bring in private investigators to monitor the activity of those employees who were injured and filed for workers' compensation.  

Also, if you are complaining that you're consistently in pain, but medical records don't back up that claim, your employer may not fully believe you, especially if you continue to seek advice of different doctors. Some pain can't be medically explained, but without the medical proof to back up your claim, your employer may not want to pay the claim and risk their premiums rising, especially if they feel as though your complaints are not valid. 

Typical Reasons for Claim Denial 

If the insurance company denies your claim, they will inform you in writing of that denial. The typical reasons for denial are: 

  • The injury you suffered wasn't serious enough 
  • The injury did not take place on the job, or within the scope of your regular job duties 
  • Your injury did not require the need for medical treatment
  • You did not require time off for your injury 

Appealing the Decision to Deny You Benefits 

If the insurance company is denying you benefits, you'll receive a written notification in the mail. The first thing you should do is to call the insurance company to talk to them about why your claim was denied. If they refuse to reverse the decision (which they probably will), retain a workers' compensation lawyer such as Lloyd E Bennett to start the process of initiating an appeal. You do have the right to be compensated when you are injured on the job, so if you feel your denial is not justified, you should take it through the appeals process. 

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