How Often Are Workers’ Compensation Claims Denied?

Did you know a significant number of workers’ compensation claims are denied in the first go? Many may get approved in the appeal stage. Having an experienced workers’ compensation lawyer by your side can greatly improve your chances of an approved claim.

What are some of the common reasons for claim denials?

1. Your injury/condition falls outside of state guidelines: While some states consider injuries caused by extended and persistent stress under workers’ compensation, other states are not very flexible. Your reason for rejection could be that the injury does not fall under the category of workers’ compensation related injuries.
2. A missed deadline: Workers’ compensation claims filing process is lengthy and complex, involving multiple stages and associated deadlines. The timeline to file your claim is dependent on the guidelines provided by your state. Some allow 30 days, whereas others have a provision of filing claims up to 3 years after the injury occurred. It is important to track your application and make sure you do not miss any submission deadlines. Moreover, it is also crucial you report your work-related injury to your employer immediately.
3. A pre-existing condition: It is very common for insurers to try to link your injury to a pre-existing condition to avoid paying workers’ compensation. In case of such a dispute, the claimant must prove that the injury is work-related and provide medical records that support this claim.
4. Misrepresentation: If your application is found to have exaggerated or fabricated medical conditions, it will be denied outrightly. Make sure that you provide a true and accurate picture of your injury and support it with your doctor’s statement, diagnosis, prescription and other treatment details.
5. Filing a claim after leaving the job: Some insurance companies deny claims submitted by former employees as they believe the injury was not severe enough to file a claim while on the job. In other cases, it has been observed that employees who have been laid off file claims as an act of hostility or revenge. Nevertheless, if you have a valid reason and medical records that prove that your injury is work-related, despite you leaving the job, your case may be approved.

To understand the ins and outs of workers’ compensation application process, it is suggested you engage a legal professional, a workers’ compensation attorney, from the start. They will assist with all the paperwork, gather evidence and records, and make sure your application is complete, accurate and submitted in a timely manner.

At Kenton Koszdin Law Office in Van Nuys, we are on a mission to help those hurt on the job avoid becoming victims of companies and their insurance providers. Our expert attorneys will help your claim and navigate the application process for the best possible outcome for you and your family. Call 818.293.4980 for your initial free consultation.