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What to do after a workers’ compensation claim denial

On Behalf of | May 8, 2024 | Workers' Compensation |

A workplace injury can be stressful, leaving you with physical pain and financial burdens. Receiving a denial for your workers’ compensation claim only adds another layer of frustration. Before you speak with your employer or insurance company, you need to understand the potential reasons they are denying your claim.

Reasons for claim denial

Denials can happen for various reasons. Understanding the reasons for the denial is crucial so you can address it properly and effectively.

  • Work-relatedness: The insurance company may question whether your injury really happened while you were on the job. To strengthen your case, you must gather evidence like witness statements, incident reports or photos.
  • Timeliness: There are strict deadlines for reporting injuries and filing claims. You may double-check your state’s regulations just to ensure you submitted the reports on or before the intended deadline.
  • Medical documentation: Missing or incomplete medical records can weaken your claim. Make sure your doctor clearly states that your injuries resulted from work-related duties and connect your injuries to your work duties.

These are some of the common reasons for denial, but you may speak with legal professionals to help you understand other factors that contributed to your claim denial.

Taking action after a denial

Do not lose hope or get discouraged after a claim denial. Once you get your denial letter, review it carefully and check the deadline for appealing the decision. This will help you strategize the next steps, especially if you are planning to file for an appeal.

Ensure that you have collected documents and other evidence to support your claim. This includes medical records, accident reports, witness statements and proof of lost wages.

Workers’ compensation should protect you during a challenging time. By understanding the process and your rights to a claim after an injury, you may increase your chances of a successful appeal.