A sudden slip on a wet floor or a sharp pain from lifting a heavy box can turn an ordinary workday into a moment that changes everything — and most injured workers expect workers’ compensation to be the safety net that catches them. After reporting the injury to a supervisor as soon as possible, the worker typically anticipates being sent to an approved medical provider, having the injury documented and filing a claim that covers necessary treatment and a portion of lost wages while they recover. In theory, the process should be straightforward: follow medical advice, submit any required forms and wait until benefits begin.
But what happens if the provider denies the claim? These denials often cite “insufficient evidence,” a dispute about whether the injury was work-related or missed deadlines. This can lead to frustration, but injured workers need to remember that this is not the end of the process. They do have additional options.
Steps to take if denied workers’ comp benefits
Although the exact process varies depending on the details of the case, the following provides a general outline that can help you to have an idea of what to expect:
- Identify the stated basis for denial. First, review the denial for the reason behind the decision. Common examples include late notice, no employer coverage, independent contractor classification, injury deemed non work related, preexisting condition, lack of medical support or intoxication.
- Note important deadlines. Many jurisdictions have short appeal windows. Missed deadlines can terminate the claim.
- Secure medical care and build objective proof. Continue treatment within applicable network rules. Request complete records potentially including emergency records, imaging, work status and referral notes. Also gather evidence about the accident such as a copy of the incident report, witness names, photographs, safety logs and training records.
- Begin appeal process. Review required paperwork and begin preparing your case, review documentation and update information to better ensure approval the second time around. Before filing, confirm forum rules, filing method and service requirements. A defective filing can trigger dismissal.
- File the paperwork. File the appeal within the statutory deadline listed in the denial notice. Submit supporting evidence and prepare for deposition, hearing and cross examination.
A denial does not end a claim. It starts a contested process governed by deadlines, medical proof, credibility. Injured workers have options to fight back after a denied workers’ compensation claim. The process can be complicated, but legal counsel can work with you to better ensure you have everything in order and increase the likelihood of an approval.