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Why might a workers’ compensation claim be denied?

On Behalf of | May 17, 2024 | Workers' Compensation

Workers’ compensation provides assistance when someone is injured while on the job. It covers medical costs and lost wages. However, not all claims for workers’ compensation are accepted. 

Understanding the common reasons for denial will help employees navigate the complexities of the process more effectively.

Inadequate documentation

One reason claims are denied is inadequate documentation. Employees must provide sufficient medical records that link the injury directly to their workplace activities. Missing medical reports, incomplete forms or insufficient evidence demonstrating that the injury occurred while at work can lead to a claim being rejected.

Reporting and filing deadlines

Failing to report an injury to an employer within the required timeframe or delaying the filing of a claim can result in denial. Employees should act promptly and adhere to these timelines to ensure their claim is considered.

Disputes over the injury’s origin

Claims often get denied when disputes occur about whether the injury occurred on the job or if it was pre-existing. The Bureau of Workers’ Compensation may argue that the injury was not work-related or was due to non-work-related activities. In such cases, additional evidence and sometimes legal intervention may be necessary to resolve the issue.

Non-compliance with treatment plans

If an injured employee does not follow the prescribed treatment plan or fails to show up for medical appointments, their claim may be jeopardized. The Bureau of Workers’ Compensation can deny claims if they believe the employee is not taking reasonable steps to recover from the injury, arguing that non-compliance could indicate that the injury is not serious or is being exaggerated.

Understanding these common pitfalls can help employees ensure their workers’ compensation claims are processed smoothly. If a claim is denied, employees may consider seeking guidance to appeal the decision effectively.