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What to Do If Your Workers Comp Claim Is Denied

Every hour in the United States, about 500 workers are injured on the job. Stretch this to a year and you’re looking at over 2 million injuries.

While a workplace injury can cause you untold physical and emotional pain, it can also keep you out of work for several weeks, months, or even years. This means you will not be in a position to earn a living.

Fortunately, employers in the U.S. are legally required to purchase workers’ compensation insurance. After you’ve been injured, you’ll file a workers comp claim and wait for the money.

Unfortunately, your claim can be rejected. If you’re in this situation, what should you do?

Keep reading for more information.

Why Can a Workers Comp Claim Be Rejected?

Before diving into what to do after your claim is rejected, it’s important to understand why a claim can be turned down in the first place.

In most instances, your employer’s insurer will make you a lower offer. This is normal because you’ll then negotiate and reach a settlement. But if the insurer rejects the claim outright, then they must have a good reason, along with evidence.

A common reason is a discrepancy between your report and medical records. If you report that you fell and injured your spine, for instance, yet medical records show that something fell on you, the insurance company will certainly deny the claim.

It’s important to be truthful to your employer as well as the workers comp orthopedic doctor you’ll see after the injury.

Failing to report your injury immediately (or within the allowed time) is another common reason insurers reject workers comp claims. And if there’s no witness to confirm your version of events, there’s a good chance your claim will fail, especially if the medical report doesn’t explicitly support your report.

Your Next Steps

Here’s what you should do after your claim is rejected:

Appeal the Decision

Your employer or their insurer will let you know why the claim was denied.

If the reason is a clerical error or you failed to provide a document that’s readily available, you simply need to rectify the mistake and file the appeal. You will have a specified period of time to file the appeal, so ensure you adhere to the timeline.

Hire a Worker’s Comp Attorney

If your claim has been rejected, it’s likely that you filed it without the input of a worker’s comp attorney. If you had hired this lawyer, they would have pointed out any gaps and helped you file a claim that won’t get denied.

But if there was ever a second-best time to hire a worker’s comp attorney, it’s immediately after your claim is denied. Your lawyer will assess your situation and determine the best way to proceed.

Some cases, especially where large amounts of money are involved, can be complex, so the lawyer might decide to pursue the matter in a court of law.

Get the Compensation You Deserve

Sometimes your employer or their insurer will have a valid reason to reject your workers comp claim. And other times they may reject it unjustly. Either, knowing what to do when your claim is denied will make a big difference in your quest to get compensated.

Keep reading our blog for more workplace tips and advice.