Why Were My Claim Denied? 5 Reasons For Workers’ Comp Denial

Workers' Comp Denial | DYS Law Group

When you’re injured at work, the last thing you want to worry about is whether or not your workers’ compensation claim will be denied. Unfortunately, denial rates for workers’ compensation claims are relatively high. In fact, according to one study, nearly 60% of all initial claims are denied.

There are several reasons why your claim could be denied. In this blog, we’ll go over some of the most common reasons for the denial and what you can do if your claim is denied.

What Exactly is a Workers’ Comp Denial?

A workers’ comp denial is a decision by an insurance company not to approve a claim for benefits. This can happen for various reasons, such as the insurance company believing that the injury is not work-related or that the employee is not eligible for benefits.

You can appeal the decision if you have been denied workers’ comp benefits. The appeals process can be complex, so it’s important to understand your rights and options before deciding whether to proceed.

If you have been injured at work, contact a workers’ comp attorney to discuss your case and find out if you have a valid claim for benefits.

5 Common Workers’ Comp Denial Reasons

A workers’ comp denial can occur for several reasons. The most common reasons for denial include the following:

  1. The Injury is Not Work-Related
    One of the most common reasons for denial is that the insurance company does not believe the injury is work-related. To prove that your injury is work-related, you will need to have a detailed explanation of how the injury occurred. You will also need a doctor’s note stating that the injury is work-related.
  1. The Injury is Pre-Existing
    Another common reason for denial is that the insurance company believes the injury is pre-existing. To prove that your injury is not pre-existing, you will need to have a detailed explanation of how the injury occurred. You will also need to have a doctor’s note that states that the injury is not pre-existing.
  1. The Claim is Not Filed Within the Time Limit
    Another common reason for denial is that the claim needs to be filed within the time limit. To avoid this, you will need to make sure that you file your claim immediately after the injury occurs.
  1. The Employee is Not Eligible for Benefits
    Another common reason for denial is that the insurance company believes the employee is not eligible for benefits. To be eligible for benefits, you must be employed by the company at the time of the injury. It would be best if you also had a doctor’s note that states that the injury is work-related.
  1. The Injury is Not Serious Enough
    Another common reason for denial is that the insurance company does not believe the injury is serious enough to warrant benefits. To prove that the injury is serious enough, you will need to have a doctor’s note that states that the injury is serious. You will also need to explain how the injury has affected your ability to work.

What to Do If Your Claim is Denied

You have the right to appeal the decision if your claim is denied. The appeals process can be complex, so it’s important to understand your rights and options before deciding whether to proceed.

If you have been injured at work, contact a workers’ comp attorney to discuss your case and find out if you have a valid claim for benefits.

Contact And Visit Us at DYS Law Group

Whether your employer or their insurance carrier has denied your claim or stopped paying your benefits, the attorneys at DYS Law Group are here to help. We have experience handling all types of workers’ compensation claims and can help you get the benefits you deserve.

We offer a free consultation, so contact us today at (213) 855-4749 to schedule a meeting. During this, we will review your case, answer your questions, and explain your options.

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