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What to do about a workers’ compensation claim denial

If you suffer an injury or illness on the job, it’s essential that you receive immediate medical attention while also learning more about your legal rights.

Depending on your diagnosis, you may learn that you’re unable to return to work. And in that case, you’re likely to file a claim for workers’ compensation benefits.

If everything goes as planned, you’ll begin to receive payments in a timely manner and as expected. However, this doesn’t always happen, as you could receive a denial letter by mail.

In the event of a denial, your first order of business is to find out the reason. This is outlined in your letter, and may be associated with one of the following:

  • Error on your application: For example, if you neglected to include all the required information, it could result in a denial. On the plus side, this is one of the easiest mistakes to fix.
  • Did not report the injury in time: You’re required to report the injury to your employer as soon as possible. Doing so minimizes the chance of them claiming your injury occurred outside of work.
  • Your employer disputes your claim: Your employer may not want to pay your workers’ compensation claim, as it will raise their premium. So, they may dispute that your injury happened on the job.
  • Did not file the claim in time: Don’t hesitate to file your workers’ compensation claim, as delaying can result in missing an important deadline.
  • Lack of medical treatment: It’s not good enough to treat your injuries at home. You need to receive professional medical treatment to back up your claim.

Once you know the exact reason for your denial, follow the steps outlined in the letter for filing an appeal. It’s your hope that this is a simple process that wraps up quickly, but that doesn’t always hold true. You may need to stick with it all the way through a hearing with an administrative law judge.

A workers’ compensation claim denial doesn’t mean you’re out of luck. It simply means you need to file an appeal and do your part in protecting your legal rights.