Understanding workers’ compensation claim denials

Workers’ compensation is intended to provide payments to workers to cover their wages, medical expenses and other costs when they are injured at work.

Workers can suffer injuries such as cuts and bruises, strains, sprains, broken bones and traumatic brain injuries. These injuries happen in common occupations like construction, healthcare, manufacturing and hospitality.

Even though the worker is entitled to compensation, there are situations when the worker’s claim is denied.

Claim denials

Workers’ compensation claims may be denied for several reasons. The claim may be denied because the worker did not meet the eligibility requirements. The most common reasons for denial include timeliness issues, insufficient evidence and injury or treatment issues.

The claim must be filed on time and the injury must be reported on time. If they are not, that may be a reason for denial. The claim may also be denied if the injury is not payable under workers’ compensation, if the worker did not receive medical treatment, if there is insufficient evidence that the injury is work-related or if the employer disputes the claim.

It is important for the worker to ask for a copy of the denial letter, which explains the reason for the denial and also addresses the worker’s appeal rights, including the deadline for filing an appeal. Sometimes, a denial is caused by an administrative or clerical error that can be resolved before filing an appeal.

If the worker chooses to appeal, he or she should be prepared to bring documentation, including medical records, to address the denial. It’s important that workers receive the compensation they are entitled to and experienced attorney can help.