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Reasons for workers’ compensation denials

On Behalf of | Dec 30, 2022 | Workers' Compensation |

Workers’ compensation insurance helps cover medical expenses and lost wages for injuries sustained on the job. However, it is not unusual for insurance companies to deny a workers’ comp claim.

There are various reasons for workers’ compensation denials. Depending on the reason for the denial, an employee may want to appeal the decision.

Common denial reasons

According to FindLaw, a denial letter will give a reason for the denial, and there are some common ones. Each state requires that an injured worker report the incident to a supervisor within a certain time frame after the injury occurred, so a denial may occur because the employee did not report on time. There is also a deadline for filing the claim, which usually must happen within 30 to 90 days after the incident.

Additional reasons for denials include:

  • There is doubt that the injury occurred at work
  • The employee did not seek medical treatment
  • The injury was self-inflicted or occurred while the worker was under the influence
  • There is not enough evidence that the injury was as bad as the employee states

How to appeal a denial

In order to appeal a claim denial, an employee must file the appeal by a certain deadline. There is usually a hearing in front of the judge. During this hearing, the worker should present as much evidence, such as medical records or witness testimonies, as possible to prove his or her case.

Appealing a denial can be a challenge. Workers’ compensation specialists provide a free and no obligation consultation for those injured on the job. Call them at 610-601-5399 or contact them online.