6 common reasons workers’ compensation claims get denied

On Behalf of | Feb 14, 2024 | Workers' compensation

When employees suffer injuries on the job, they often rely on workers’ compensation benefits to cover medical expenses and lost wages. However, some claims may not get approved, leaving workers in a difficult situation.

Six common reasons lead to the denial of workers’ compensation claims.

1. Failure to report promptly

Employees must report workplace injuries promptly to their employer. Delays in reporting can raise questions about the validity of the claim.

2. Lack of medical evidence

Insufficient medical evidence to support the injury or illness may lead to a claim denial. It is important for injured workers to seek medical attention immediately and provide detailed documentation of their condition.

3. Pre-existing conditions

A claim may not get approved for injuries related to a pre-existing condition rather than a workplace incident. Employers and insurers often scrutinize medical records to determine the extent of a workplace-related injury.

4. Missed deadlines

Workers’ compensation claims have strict deadlines for filing paperwork and making an appeal. Missing these deadlines can result in automatic denial of the claim.

5. Disputes over causation

Employers or insurers may dispute whether the injury or illness is directly related to the workplace. A claim may face rejection if there is no clear evidence linking the condition to work duties.

6. Violation of company policies

A claim may not get approved if the injury occurred while the employee was violating company policies or engaging in misconduct. This could include being under the influence of drugs or alcohol or failing to use the required safety equipment.

Understanding these common reasons for claim denials can empower employees to take appropriate steps to protect their rights and ensure they receive the benefits they deserve.