Workers’ Comp claim denied in 2023? Take these next steps

Last Updated on March 8, 2023 by Carlos Lopez

Being injured on the job can be stressful. And if your claim for compensation for your injuries and lost wages is denied, your stress level can skyrocket.

However, if your workers’ comp claim was denied, that isn’t necessarily the end of the road.

Here’s what you need to know if your workers’ compensation claim was denied:

Know the reason for denial

Sometimes, employers or their insurance companies look for any possible reason to deny a workers’ comp claim.

These reasons aren’t always valid under the law, and knowing the specific reason your claim was denied – as well as whether or not it is a legal reason for denial – is essential to understanding whether you have legal recourse in your case.

Some common reasons for denial include:

Missed deadlines

Workers’ comp claims have very specific deadlines. First, you have to report the illness or injury to your supervisor within a certain period of time, usually 30 days after you’re injured or learn that your injury/illness can be connected to your working conditions.

Once you’ve notified your supervisor, you have a specific amount of time to file your claim for workers’ compensation benefits. If you miss either of these deadlines, you may be out of luck.

You should also read:Is My Therapy Covered Under Workers’ Compensation?

Disputes about whether your injury is work-related

This is a common reason for denials, especially in the case of repetitive-use injuries such as carpal and cubital tunnel syndrome, or illnesses such as cancer or lung diseases.

Other reasons that may be used for a denial include that you weren’t working at the time of your injury, or that your injury was the result of some misconduct or negligence of your own.

In these cases, you will need evidence, such as photos and videos, witness statements, or medical records to help prove your injury was work-related.

Your condition doesn’t meet state guidelines

Some states limit what types of injuries are considered work-related, such as whether or not an illness that’s related to long-term stress at work is covered. 

You filed the claim after you left your job

If you filed your claim for workers’ comp benefits after you left your job, your claim may be denied.

However, if you can prove that your injury took place prior to your leaving your job, such as you were injured after you gave notice of your resignation but before your official last day, or that you were terminated in retaliation for reporting an injury (which is illegal), you may be able to make a case for overturning the denial.

Start an appeal for your workers’ compensation claim

If you believe your workers’ comp claim has been incorrectly denied, you can appeal the decision.

When you receive a letter stating that your claim was denied, chances are that letter will include instructions for appealing your claim. 

In many cases, your first stop in the appeals process is a hearing before an administrative law judge. This hearing may happen through a state labor department or state board of workers’ compensation.

For this hearing, you will need to present your evidence as to why you feel your claim was unjustly denied. If your employer said that your injury wasn’t work-related, for example, presenting collected medical records, witness statements, and other evidence can help in your case.

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Consider an specialized attorney

Often, workers’ comp denials can become drawn-out and complicated, and managing them can feel like a full-time job.

In these cases, enlisting the help of an experienced workers’ comp attorney can help make the appeals process less stressful and, possibly, more successful.

Many workers’ comp attorneys work on contingency, meaning you don’t pay for their services until you receive a settlement from your case. This means you won’t have to pay anything up front to receive help, and the attorney’s fees will come directly out of your settlement proceeds.

Before you leave, read some FAQ´s about workers’ compensation claim if is denied

If my workers’ compensation claim is rejected, are I still able to get medical care?

Absolutely, whether or not your claim is denied, you are still entitled to medical care for your injury.

How much time do I have to submit an appeal?

States have different deadlines for appealing decisions. To learn when to file an appeal, contact the workers’ compensation board or commission in your state.

I filed a workers’ compensation claim; may I be fired for that?

No, it is against the law for an employer to punish an employee for submitting a workers’ compensation claim.

How long does the procedure for appealing take?

Depending on the state and the difficulty of the case, the length of the appeals procedure can change. It can take a couple of months or several years.

Experienced Workers’ Comp Attorney in Washington, D.C.

Navigating the workers’ compensation system can be confusing and can add unnecessary stress when your efforts should be focused on healing from your injuries. Rather than handle everything yourself, trust Lopez Law Firm to partner with you for a positive resolution.

Our team of experienced professionals can guide you through the whole process, making your case less stressful and getting you the compensation you deserve. Schedule a consultation today!

You should also read:Hearing Loss & Workers’ Comp: What You Need to Know