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Why are workers’ compensation claims commonly denied?

On Behalf of | May 11, 2021 | Workers’ Compensation

Workers’ compensation is a form of financial support that is available to many workers when they get hurt or sick from doing their jobs. In Lexington, workers across many industries may have the option to seek workers’ compensation when their illnesses or injuries keep them from working for pay. Workers’ compensation is not automatic, however, and workers must follow specific steps to ensure that they receive the appropriate benefits.

Not every request for workers’ compensation is approved, and it is important that individuals understand why many workers’ compensation claims are rejected. This post will touch on some of the grounds for denials that workers’ compensation applicants receive, but individuals should know that this post does not provide legal advice. When dealing with a potential workers’ compensation claim or a denied workers’ compensation claim, an individual can seek the counsel of a workers’ compensation attorney to help them address their legal needs.

Denials based on timing issues

Many of the workers’ compensation claims that are denied are rejected because of technical issues, such as timing. Workers only have a limited amount of time after they are injured to report their ailments to their employers. If a worker fails to satisfy this requirement, their subsequent application may be denied based on this missed requirement.

Aside from reporting their ailment to their employer, a worker also must file their claim in time to be eligible for workers’ compensation benefits. Claims that fall outside of the appropriate window may be rejected and deemed unsuitable for approval for payment.

Denials based on lack of injury or harm

A worker who files a workers’ compensation claim that does not involve an injury or loss may see their claim denied. Generally, a worker must suffer harm in order to be eligible for workers’ compensation. If a worker cannot provide medical evidence that they suffered a work-related injury or ailment, they may be unsuccessful in their attempt to secure workers’ compensation benefits.

Denials based on employer feedback

A claim for workers’ compensation involves the acquisition of evidence and information about the individual’s injury and the event that caused their harm. An employer may dispute the facts that a worker alleges caused their harm. The employer may identify the actions engaged in by the worker as outside of the scope of their employment or an instance of horseplay. When a worker is hurt doing something that is not job-related, they may not be able to secure workers’ compensation benefits.

Workers’ compensation provides an individual with financial support when they cannot work due to a job-related injury or accident. It is not uncommon for workers’ compensation claims to be denied. There is an appeals process for them, and workers who are facing financial troubles due to their denied workers’ compensation claims can seek the counsel of trusted workers compensation attorneys for advice and help to move their cases forward.