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Common Reasons for Workers’ Compensation Claim Denial

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If you have been injured on the job, it can be the beginning of a chaotic and troublesome time. Any injury can have a major impact on your daily living, but a significant injury could keep you out of work indefinitely and bring your life to a screeching halt. Aside from the physical pain of the injury and mental strain of the sudden life change, work injuries can cause you to lose out on wages and other benefits on which your family may depend.

Workers’ compensation laws are in place to reduce the damage and relieve employees who have been injured on the job, and application for these benefits is the obvious first step. Unfortunately, some employers and insurance companies will fight any claim that arises, no matter how serious and legitimate.

During a period that is already tumultuous and challenging, receiving a notice that your workers’ compensation claim has been delayed or denied can be one of the most disappointing and disheartening experiences of this difficult time.

Workers’ Compensation Denial

If you have already been through the claims process, you have more than likely been through more trouble than you had imagined, and now it may seem like it has all been for nothing. However, it is important to realize that a denial letter is not the end of the road, and there are still steps you can take to help your claim be approved.

You should not feel overwhelmed if you do not fully understand the process. Very few people take the time to educate themselves on workers’ compensation laws and claims processes, because they never imagine it is something they will actually need. To the average person, the idea of workers’ compensation seems like an obscure safety net that you will never actually need.

But if you are injured on the job, the concept becomes an all too real necessity, and you may feel like you need a crash course. Unfortunately, the insurance companies and claims workers find faults and flaws in applications for a living, and it is their job to find a basis for denial.

Common Reasons for Denial

There are countless reasons why a claim may be denied, and insurance companies or employers will look for a number of grounds on which your claim may be dismissed. While the full list of possible reasons for denial is too long to list, there are a few common reasons which cause many claims to fail initially.

The most common reason for denial is that the claim was not filed on time. In order for a claim to even be considered, it must be submitted immediately– sometimes within as little as a few days of the injury. Both the employee and employer are required to report the claim within a specific timeframe, and you may need to take further steps to ensure that your employer is holding up their end.

The second most common basis for denial comes from disputes by the employer. For whatever reason, the company may dispute that your injury is legitimate or that it actually occurred at the workplace. This would force the applicant to gather further information and evidence, beyond the usual requirements.

Securing Representation

A qualified compensation attorney can help you with the initial filing, but proper representation can be absolutely crucial after a denial. The right attorney should specialize in the specific ins and outs of the claims process and be fully equipped to guide you through any difficulties. He or she will also be familiar with the common red flags that claims workers look for to deny claims.

If you do not already have an attorney, you should not have much trouble finding a qualified representative. Ask around to friends, family and anyone who may have already been through the same process.

You can also find any number of attorneys through a simple web search. For example, if you live in New Jersey and are looking for elder law specialists, simply type elder law attorney NJ or something similar into a search engine. You can use the same technique to find workers’ compensation lawyers in your specific region.

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