Can your workers’ comp claim be denied?

Workers’ compensation insurance has been providing an essential service for over 100 years. It ensures that if you are injured or become ill during your work duties, your medical expenses will be covered, and you will receive compensation for lost wages.

Workers’ compensation is no-fault insurance, so how could your claim be denied?

Avoiding common mistakes

There are several reasons why the insurance company may deny your claim, such as:

• Missing deadlines: In California, you must report your injury to your employer within 30 days or risk losing your right to benefits. 
• Disputes about your injury’s origin: Your employer or the insurance company could argue that your injury didn’t occur at work. This is common with repetitive stress injuries as there is typically not a specific incident leading to the injury.
• Missing medical evidence: There must be medical proof of your injury, such as paperwork from an emergency room, urgent care or a doctor’s office. Without it, there can be doubt about your injury’s severity or if there even is an injury.
• Questions surrounding the incident: If there were no witnesses to the incident or your story changes, there could be a doubt that an incident at work even occurred.

To help ensure that your workers’ comp is approved, keep the following in mind:

1. Report the incident and injury right away. Even if you think the injury is minor, having the incident documented right away can help eliminate doubt as to when and where the injury happened. Give detailed explanations while they are fresh in your mind.
2. Seek medical treatment as soon as possible so that the details are documented and you have the beginnings of a paper trail regarding a diagnosis and treatment.
3. Follow your company’s guidelines for reporting injuries and seeking treatment. Your employer likely has a list of providers that you can choose from for initial treatment.
4. Save all your documentation and ensure you have copies of the initial claim, injury reports and communication from your employer and the insurance company.

If your claim is denied, you can appeal the decision. It’s important that you have someone to help you understand your legal rights and the appeal process. With their assistance, your claim has a better chance for approval.