Workers’ compensation claims are denied by insurance companies for various reasons. If your claim is denied, it can be confusing trying to figure out what your next steps should be. The following article will provide information regarding some of the most common reasons why workers’ compensation claims are denied by insurance companies, as well as some steps you could take if your claim is denied.
What are Some Reasons Why Workers’ Compensation Claims are Denied?
Workers compensation claims can be denied for any number of reasons, some of which include:
- You failed to meet an applicable deadline. If you do not file your claim within the appropriate timeframe or fail to properly notify your employer of your accident, your claim may be denied.
- Your accident report and medical records are inconsistent. If the accident report that you provided to your employer does not match the information that is on file in your medical records, your claim will likely be denied.
- Your injury was not work related. In order for your injury to be compensable, it must have occurred within the course and scope of your employment.
- You failed to seek medical care for your injuries. If you failed to seek appropriate medical care for your injuries in a timely manner after you were injured, an insurance company may deny your claim, under the assumption that your injuries must not be significant.
- You were injured while under the influence of drugs or alcohol. If the injury you sustained at work was the result of being under the influence of drugs or alcohol, that injury will not be covered under workers compensation.
What Should I Do if My Claim is Denied?
If your workers’ compensation claim is denied, you should consider taking some of the following steps:
- Review the denial letter. After receiving a denial letter, you should closely review the letter to ensure that you comprehend the reason(s) why your claim was denied. This is especially important because it might turn out that either you or the insurance company made a simple error that could be rectified by a simple phone call or email. If you happen to notice any errors on the denial letter, contact the insurance company right away in order to determine whether the error can be fixed.
- Contact an attorney. If there was some substantive basis for the denial of your claim, you may want to consider contacting a workers’ compensation attorney to help you determine what steps you should take. This attorney will let you know whether you should file an appeal and will ensure that you meet any applicable deadlines. Alternatively, if you decide to opt out of the workers’ compensation process altogether and file a personal injury lawsuit against your employer instead, an attorney can provide assistance throughout that process as well.
- Consider filing an appeal. If you receive a denial letter, the letter should contain relevant information regarding how to file an appeal, including any applicable deadlines you must adhere to in order to file a timely appeal. The appeals process will typically involve an administrative hearing where you will be required to present additional evidence to support your claim.