4 Reasons Workers’ Compensation Claims Are Denied

The Social Security Administration (SSA) notes that workers’ compensation was the first social insurance to develop in the U.S., and it still protects workers today. The SSA reports a total benefits payment of $63.6 billion in 2013. However, submitting a claim and receiving benefits can be a complicated process, and there are four primary reasons a claim may be denied. 

Delayed Reporting

As soon as you become injured in a work accident, it’s critical that you report the incident right away. If you delay reporting, your legitimate claim may be denied. The following are reasons to report an accident as soon as possible:

  • Workers’ compensation insurers may assume that the accident wasn’t legitimate or that you weren’t actually hurt.
  • Reporting the injury and filing a claim quickly provides you with a better chance of meeting reporting and filing deadlines.

Delayed Medical Treatment

Seeking immediate medical attention for your injury is an important component of a successful workers’ compensation claim. Getting treatment right away shows insurers that you take your injury seriously and want to prioritize healing. It’s important to follow your doctor’s instructions and not return to work until you’re fully recovered.

No Witnesses

Workers’ compensation claim-reviewers may doubt the injured party who says no one saw the accident that caused his injury. In these cases, insurers must rely solely on your word and the evidence from your medical report. If no one saw your accident, it’s important you inform your supervisor immediately, and tell every person the exact same story. Any inconsistency could hurt your claim.

Medical Report Does Not Support Accident Report

It’s important that the accident description you give your supervisor is the same as the one you give your doctor. Even slight changes in that description can negatively impact your claim because insurers review a case to confirm that:

  • Your version of events is consistent across all those you’ve discussed it with
  • Your version of events is consistent with a doctor’s description of your injuries

You Need an Attorney

If you worry your claim may be denied, it’s smart to speak with a lawyer. The legal team at Kirshenbaum & Kirshenbaum can answer your questions and help you through the claims process. To speak with a member of our team, fill out the online contact form on our website.


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