Filing a workers’ compensation claim can be stressful, especially when you are already dealing with an injury and time away from work. Unfortunately, not every claim is immediately accepted.
A claim may be disputed for several different reasons. Understanding some of the common issues can help injured workers better understand what may be happening with their claim.
1. The Injury Was Not Reported Promptly
Employers generally need to know about workplace injuries so that the incident can be documented and the workers’ compensation process can begin.
If an injury is reported much later, questions may arise about when and where the injury occurred.
2. The Employer or Insurance Company Disputes the Injury
An insurance company may question whether an injury actually occurred at work or whether the injury is connected to the employee’s job duties.
This can be particularly complicated when an injury develops gradually rather than resulting from one specific accident.
3. There Is Not Enough Medical Evidence
Medical documentation can play an important role in a workers’ compensation claim.
Your medical records should clearly explain your diagnosis, treatment, symptoms, and the connection between your condition and your work when appropriate.
4. The Insurance Company Disputes the Extent of the Injury
Sometimes the existence of an injury is not the main issue. Instead, there may be disagreement about how serious the injury is or how it affects your ability to work.
This may become especially important when an injury results in continuing limitations or a permanent impairment.
5. The Claim Involves a Preexisting Condition
A previous medical condition does not necessarily mean that a workplace injury cannot be covered. However, an insurance company may raise questions about whether your current condition is related to your employment or another cause.
Medical evidence can be important when addressing these questions.
What Happens If Your Claim Is Denied?
A denied claim does not necessarily mean the end of your workers’ compensation case. Depending on the circumstances, you may have options for challenging the denial and presenting additional evidence.
The appropriate next step will depend on why the claim was denied and the specific facts of your case.
What Should You Do After a Denial?
Start by reviewing the denial and understanding the reason given by the insurance company. Keep copies of all notices and correspondence and continue following your medical treatment plan.
If you do not understand why your claim was denied or what you should do next, speaking with a workers’ compensation attorney may help you understand your options.
