Reasons for a Worker’s Compensation Denial and Your Next Steps

Did you file your claim on time? Did you report your injury to your supervisor? There are so many reasons that an employer may deny your workers’ compensation claim. However, just because you receive a denial letter does not mean that your claim is finished. You do have a right to appeal the decision. However, before you appeal the denial, it is beneficial to understand why your application was rejected.

Five Reasons for a Denial

You might be anxious about getting a denial, but it is not the end of the line. While there are plenty of reasons your injury claim might be denied, there are at least five common reasons for denials.

  1. Timeliness

    While an injury happens in an instant, and recovery can take months, there is a specific window for reporting and filing claims. For example, in Colorado, you need to notify your employer of your injury within four days, in writing. Also, beyond informing your employer, you need to file a claim within 30 to 90 days, depending on your state. 
  2. Employer Dispute

    Your employer may not agree with your explanation of your injury. For example, they might feel the injury was a result of horseplay, or that it didn’t occur during work. However, whatever their disqualifying reason, it will be listed in the denial letter.

  3. Unprovable Injury

    Some injuries are not physical but psychological. Unfortunately, these types of injuries, like stress-related injuries, are difficult to prove, which means that showing a compensable injury may not be possible.

  4. No Medical Treatment

    If you do not seek medical treatment, then it can be difficult to prove an injury. Therefore, most states dictate that you must receive medical care to get access to compensation benefits.
  5. Insufficient Evidence

    Some claims are denied on merit while others are dismissed because of insufficient evidence. Your job when applying for workers’ compensation is to prove your injury and that it occurred at work. Therefore, if denied based on inadequate evidence, appeal and submit additional evidentiary support.

Steps to Take After a Denial

After you receive a denial letter, there are a few things you can do: (1) accept and move on, (2) contact your employer or (3) appeal with a lawyer. Accepting is often not the best option, especially with a legitimate claim. However, reaching out to your employer can often resolve accidental denials. Some denials are the result of a clerical error. Although, if you chose to appeal, be sure to hire an experienced workers’ compensation attorney.

Denial letters can lead to anxiety but don’t think that these initial responses are the final say. Contact a workers’ compensation lawyer in Milwaukee, WI and get the help you need.

 

Thanks to Hickey & Turim, SC for their insight into workers compensation and what to do after a denied claim.