What to Do if a Workers’ Compensation Claim is Denied?

  • Having a workers’ compensation claim denied is one of the most devastating things an injured worker can experience. You’ve given your time, energy and loyalty to your employer, only to have your claim or a much-needed medical procedure denied.

    Employers and insurance companies deny work comp claims for many reasons, which we’ll look at in greater detail below. The good news is that, even after a workers’ compensation denial, you still have many options, including…

    • Filing an appeal
    • Seeking to have your claim reopened
    • Exploring third-party liability claims or other legal options.

    The path you choose to take depends on the specifics of your situation. For some workers, an appeal could be the most reasonable course of action to get the benefits you deserve. For certain types of workers who have suffered a specific type of injury, a third-party liability claim might be ideal. Before we dive into these options, let’s look at why workers can be denied work comp benefits.

    Why Workers Don’t Get the Benefits They’re Entitled To

    There are countless obstacles workers might face after being injured on the job. Workers’ compensation benefits are supposed to be given on a “no-fault” basis, which means it doesn’t matter who was responsible for the injuries; a worker should still be immediately eligible for benefits after a work-related injury.

    Unfortunately, workers are often denied compensation. Reasons include…

    • Employers allege that a worker’s injury is pre-existing.
    • Employers allege the worker was impaired when a workplace incident occurred.
    • Employers say that the injury wasn’t reported or filed on time.
    • An insurance company says that a certain procedure isn’t necessary.
    • An employee is misclassified as a contractor and, thus, is ineligible for benefits.

    Employers or insurance companies can deny claims for many other reasons, but the above list encompasses many of the common reasons that workers have their benefits denied. Once a worker faces a denial, what comes next?

    What to Do if a Workers’ Comp Claim is Denied

    After a denial, your first step should be contacting a workers’ compensation attorney to prepare your next course of action. The reason your claim was denied will play a big role in determining which path to take.

    Filing an appeal – This is the most common path workers take to make their case for workers’ compensation. In an appeal, you and your attorney set forth an argument for why your injury should be covered.

    Reopening your workers’ compensation claim – Claims might be reopened for many reasons. For example, if a worker’s physical condition changes or the responsibilities that they currently have at work are no longer available, that worker might seek to reopen a claim. Though appeals are more common, specific situations do call for reopening a claim.

    Third-party liability claims – For workers who aren’t covered by workers’ compensation, or for those whose injuries can’t be adequately addressed through compensation, third-party liability claims might be an option. In these cases, a worker bypasses work comp entirely to pursue a personal injury claim against the party responsible for their injuries.

    For Help with a Denial, Contact a Workers’ Compensation Attorney

    Once you meet with an experienced workers’ compensation attorney, you will find out more about your options. These are just a few examples of what workers do when their claim is denied. Your path to work comp benefits could be different.

    If you’ve suffered a workplace injury, remember to seek immediate medical attention and notify your supervisor as soon as possible. Once you’ve received treatment, you should begin filing a claim with your employer. An attorney can also be valuable in this part of the process. Making sure your claim is properly filed and your case is clearly made is the best to make sure you are getting the benefits you are entitled to. Our attorneys at Coriden Glover, LLC want to ensure that every injured worker receives the care they deserve.