Reasons Why Your Workers Compensation Claim Was Denied

6 Common Reasons for Denial of Workers' Compensation Claims - Woodruff  Johnson & Evans Law Offices

Workers’ compensation benefits cover medical expenses and lost wages when workplace injuries prevent individuals from performing their jobs for extended periods. Unfortunately, insurances companies deny benefits for these reasons.

Failure To Meet The Filing Deadline

Most states require workers to report accidents as soon as possible. Still, a workers compensation attorney Oregon must confirm that a client meets the state’s strict filing deadline before investigating a claim denial. Failure to do this may make workers ineligible to receive benefits.

The Employer Denies the Injury Is Work-related

A worker can file a claim for benefits directly with the insurance carrier. Still, the insurer will deny benefits if the employer insists that the injury occurred during a break or commute. In addition, workers’ compensation claims lead to higher insurance premiums, and unfortunately, some employers reject claims to minimize their out-of-pocket costs.

Lack of Witness Accounts

When employers dispute workers’ compensation claims, insurers may seek co-workers’ testimonies to determine injury circumstances. Unfortunately, many people worry about retaliation if they contradict their employers and may be unwilling to provide evidence to support a valid claim. Thus, a lack of evidence from both employers and co-workers can lead to a claim’s denial.

Lack of Medical Evidence to Support a Claim

Except for emergency treatment, most employers and insurers choose the provider who examines and treats the worker. In addition to requiring workers to seek prompt medical attention, insurers also require medical evidence to support the injury. Evidence includes a list of tests to confirm a diagnosis, anticipated treatment and recovery periods and a medical provider’s estimate for when the employee can resume working.

Incomplete Paperwork

Claim paperwork that is missing information or has inaccuracies can prevent workers from meeting filing deadlines and result in automatic claim denials.

The Injury is Pre-Existing

Injured workers can receive benefits despite having pre-existing conditions. However, in such cases, they must provide substantial medical evidence proving that a job-related accident was the main contributing factor for the condition’s worsening.

Injured workers who know their rights can launch successful appeals to reverse denials for workers’ compensation benefits.