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3 common reasons for a workers’ compensation claim denial

On Behalf of | Sep 20, 2023 | Workers' Compensation

When an employee suffers an on-the-job injury, workers’ compensation is often their financial safety net.

However, not all claims come with approval, leaving many workers frustrated and confused. Here are three common reasons why workers’ compensation claims get denied.

1. Late reporting of the injury

One of the most common reasons for workers’ compensation claim denials is the delayed reporting of the injury. Employers and insurance providers require prompt notification of any workplace injury. Failure to report the injury within 30 days and file a claim within a year can result in a denied claim. To avoid this pitfall, employees should notify their supervisor immediately after an incident, even if the injury appears minor at first.

2. Lack of medical documentation

Workers’ compensation claims rely heavily on medical evidence. A denied claim often occurs when there is insufficient or conflicting medical documentation. Employees should seek prompt medical attention and provide detailed information about their injuries to healthcare professionals. Accurate and comprehensive medical records play a pivotal role in ensuring a successful claim.

3. Pre-existing conditions

Another common reason for claim denial is when an injury exacerbates a pre-existing condition. Insurance providers may argue that the injury did not cause significant harm beyond the existing ailment. To overcome this hurdle, employees should ensure their medical records clearly document the extent to which the work-related injury worsened their pre-existing condition.

Workers file approximately 4.9 million workers’ compensation claims every year, but not all of them get approved. By staying informed and diligent, workers can better navigate the system and secure the support they need during their recovery.