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  • Christopher Le

Reasons Why Your Workers Comp Claim Is Being Denied

Updated: Aug 13, 2019

Insurance companies are not your friend and are looking for ways to deny your workers compensation claim. The following errors could cost you a favorable decision.

Missing Deadlines

Workers’ compensation claims have stringent deadlines, and missing them may cause your claim to be denied. It’s important to submit the following information in a timely manner or risk having your claim denied:

1. Timely Reporting - Not only must you notify your employer of the injury in a timely manner but it is imperative you fill out an incident report so that your injury is documented.

2. Workers Compensation Claim Application - This form must be filled out and filed with the Division of Workers Compensation office in your local area. This form puts all parties on notice of your injury.

3. Claim Appeals - If your initial workers compensation claim is denied, the denial letter will provide you with an appeal deadline date. Make sure to read carefully the documents you receive from the insurance carrier.

Missing Specific Information

It is important to include all information related to your work related injury when filing a workers compensation claim. Here are a few tips on what detail is required:

1. Date of Injury - It is important you know the exact date you were injured. A wrong date of injury could lead to a denial by the insurance carrier.

2. Witnesses - Listing the names of witnesses that were present at the time of your injury could help your claim, especially if they are willing to provide a statement about what they observed.

3. Injured body parts - Remember to list all body parts that were affected by your injury. Make sure to list even the slightest of injuries. Certain body parts may be denied by the insurance carrier if they are not listed on the initial incident report or on the workers compensation application.

4. Medical Records- Medical records can help substantiate your claim. The closer in time you receive medical treatment after your injury, the stronger your case becomes. A large gap between your injury date and your first medical visit could cause your claim to be denied.

Insufficient Medical Documentation

The lack of medical evidence is one of the main reasons a claim is denied. It is paramount, that not only should you immediately seek medical attention after you’ve been injured, but you should submit all medical records and related documents to support your claim. Many times, insurance carriers will look for inconsistencies between the injury report and medical records, so make sure you provide sufficient information to your doctor so they can document your complaints in the records. It’s important to find a doctor who is experienced in handling workers compensation claims as their medical reports can help increase your chances of a favorable decision.

Furthermore, make sure to abide by doctors orders. If you are non-compliant with doctors orders, such as refusing treatment or failing to take medications as prescribed, you risk losing your workers compensation benefits. If your doctor takes you off of work, restricts you from working at full capacity, or reduces your hours, it is important to follow their orders.

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