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8 Common Reasons Workers’ Compensation Claims Get Denied

By: Ed Smith


How Your HR Department Handles Workers Comp Claims

Workers’ comp claims allow thousands upon thousands of workers to deal with the financial blowback of workplace injuries every year. That being said, navigating this process can be difficult if you’re unaware of the guidelines surrounding workers’ comp claims. Educating yourself about the nature of workers’ comp claims, and relying on the help of a qualified attorney, can do wonders for your case. Firstly, you must know the reasons workers’ comp claims can be denied. There are eight common reasons workers’ compensation claims get denied:

1. The Injury Was Not Technically a “Workplace” Injury

To qualify for workers’ comp, two requirements must be met. Firstly, it’s crucial that the injury occurred during the course and scope of your employment, and due to a task that you were performing for your job. Secondly, you need documentation and other evidence that proves this is the case. With the right workers’ compensation attorney, you can navigate this process much more quickly.

2. You Waited too Long to Report Your Injury

You must report your injury ASAP if you want to qualify for a potential workers’ comp claim. If you fail to notify your employer, and the insurance company that handles workers’ comp claims for the company, you put yourself at risk. The sooner you handle the entire workers’ comp claim report, the more likely you’ll be to receive a payout.

3. There Were No Witnesses to Your Injury

One of the most common reasons workers’ comp claims are denied early on is due to a lack of credible witnesses to your injury. Video footage can be beneficial in this regard, so be sure to get a hold of it quickly if you’ve suffered a workplace injury. Being sure to document any interactions you’ve had with witnesses to your injury is crucial as well.

4. The Injury You Suffered Isn’t Covered

Unfortunately, there are injuries that are simply not covered by workers’ comp. Since these injuries are covered via insurance policies, rather than through a government agency, they follow different legal guidelines. If your injury is determined to be primarily contributable to your daily lifestyle outside of work, it may be harder to link your workplace injury to a successful workers’ comp claim.

5. You Fail to Cooperate with the Workers’ Comp Process

Being active and compliant with every step of the workers’ comp process is critical. You need to cooperate in all ways that you’re instructed to. Every time you refuse to cooperate, you’re giving the insurance company ammunition that they can use to deny your claim. If you feel you’re being asked to cooperate in an illegal fashion, you need to contact a workers’ comp attorney ASAP.

6. There are Discrepancies in Your Report

Keeping your report as uniform and clear-cut as possible is crucial to your chances of successfully receiving a workers’ comp payout. If the insurance company paying out the claim can easily poke holes in your report, and point out discrepancies, you’ll have a hard time convincing them to payout without the additional help and intervention of a workers’ comp attorney.

7. You Have a Relevant Pre-Existing Condition

Unfortunately, having some pre-existing conditions can make it difficult to successfully receive a workers’ comp payout. It’s your responsibility to let employers know about any pre-existing injuries or conditions you may have, so they can provide you with the protection and medical considerations that you need while on the job. People with pre-existing conditions often require an attorney’s assistance to fight against improperly denied claims as well.

8. You Started a Fight

Employees that are injured in a fight that they started are not eligible for workers’ comp claims. That does not stop employees in these situations from trying, however. That being said, your claim will be denied quickly if you try to take advantage of the workers’ comp system after an at-work fight (that you started).

Workers’ Compensation Claims Can Help You Recover

After you’ve suffered a workplace injury, the sheer amount of physical and financial fallout that can occur is difficult to overstate. For this reason, you must never forget that it’s your right to file a workers’ comp claim. As long as you follow the process, stay cooperative, and get a talented workers’ compensation attorney involved, you’ll be likely to receive the workers’ comp payout that you need. Never rush the process, and ensure you document every single step of the process to ensure you have the evidence you’ll need to succeed.

Published: November 13, 2022

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Ed Smith

Ed Smith developed a keen understanding of business through his studies and early business ventures. He now looks to advise start-ups and is extremely keen to make sure every entrepreneur gets the advice which could make their business venture a success. He has been a guest author on various high authority business sites.

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