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Why was my workers' comp claim denied, and what should I do now

You may never expect to get injured at work, but it is a relief to know there is a system in place to compensate you for your medical bills, lost wages and other qualifying costs. If you have never had to file a claim for workers' compensation, the process may seem complicated. However, it is worth the effort to obtain the funds you need to prevent your family from falling into financial trouble from the expenses related to the workplace injury.

After filing the appropriate paperwork with your employer, you may have been shocked to receive notice that the insurer had denied your claim. Does this mean you will be left to cover the cost of your treatment and to somehow find a way to catch up from the days or weeks of pay you missed when you were unable to work?

Denial is not the final word

If you believe your employer's workers' compensation insurer denied your claim in error, you have some work to do. Your next step is the appeals process, and that begins by determining the reasons why the insurer rejected your application for benefits. Some of the common reasons why an insurance company will deny workers' compensation claims include the following:

  • Your accident occurred outside of work-related events or because your actions were in violation of safety rules.
  • Your injury is not among those covered by your employer's insurer or by state law.
  • You did not report your injury to your supervisor within the deadline mandated by California law.
  • You did not file a claim with the insurer within the time limit.
  • You failed to provide the insurer with evidence that you received medical treatment, or you did not follow through with your doctor's orders.
  • Your employer disputes the validity of your claim.

To appeal the denial of your workers' compensation claim, you have a limited amount of time to gather documentation and file the appropriate paperwork. Once you know why the insurer denied your appeal, you will be better able to provide the evidence necessary to attempt to overturn the denial, such as further medical tests or the corroboration of witnesses.

If the denial is based on your employer's recommendation, you may begin by meeting with your boss and trying to clear up any misunderstandings about your accident. If this doesn't resolve the matter, consider contacting an attorney who can help you through the complex appeals process.

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