What to do about a denied workers’ comp claim

If you get an on-the-job injury, you expect workers’ compensation insurance to cover it. Unfortunately, this does not always work out. If you receive a claim denial, you probably feel a lot of frustration and confusion.

Thankfully, it is possible to challenge your claim denial. Here are the next steps you should take if your claim for workers’ compensation does not result in benefits.

Understand why you received a denial

The first step you need to take is to figure out what led to the claim denial. This should be evident in the letter you receive. Potential reasons for claim denials include the following:

• You missed the deadline: In order to get benefits, you must report your accident and file your claim within a certain time frame. If the deadline passes without you reporting your injury, the insurance company will likely deny your claim.
• Your employer disputes the validity of your claim: Your employer may tell the insurance company that you sustained the injury outside of work or that it was due to misconduct.
• There is insufficient evidence: The denial letter may say you did not receive medical treatment for your injury or it is not clear your accident was work-related.

There are more reasons why the insurance company may reject your request for benefits, but these are the most prevalent examples.

Appeal your claim

Once you determine why your claim was denied, it is time to appeal it. The letter you receive should include the time frame during which you may file an appeal. Before you file an appeal, you will want to collect as much evidence as you can to refute the claims made in the denial letter. For example, you may want to get another medical exam to prove your injury.

If you decide to appeal the denial, keep in mind it is a complex legal process. You should talk to an attorney to figure out what you should do.