Common Reasons Workers’ Compensation Claims Are Denied

The workers’ compensation system was created to give employees immediate payment for a work injury without the need to file a lawsuit against an employer. However, that does not mean all workers who submit claims will automatically be approved for benefits. If your workers’ compensation claim was denied, your next steps depend on the reason given for the denial. When your workers' comp claim is denied

Reasons a Workers' Compensation Claim May Be Denied

It is important to understand that your benefit case is not closed if your claim has been denied. If your application simply needs more documentation to establish a work injury, you could be able to file a workers’ compensation appeal to get the benefits you are owed. 

There are common reasons for a denial of workers' compensation benefits, including:

  • Insufficient medical evidence. Most workers must obtain medical treatment in order to be eligible for workers' comp benefits. They must also have reasonable proof that the injury is work-related, such as the injury occurred in the workplace or during the employee’s regular shift.
  • Delayed filing or reporting. In Rhode Island, employers are required to submit a claim to the company’s insurance carrier within 10 days after a work-related injury occurs. If you do not report the incident right away, your employer may miss the deadline, and your legitimate claim may be denied.
  • Delayed or inconsistent medical treatment. Getting treatment right away shows insurers that you take your injury seriously and want to prioritize healing. Following your doctor’s instructions, keeping follow-up appointments, and not returning to work until you’re fully recovered will benefit your claim as well as your health.
  • Disputed claim by the employer. If your employer suspects that your accident happened outside of work, was the result of horseplay, or happened for a reason that disqualifies you for benefits, the insurance provider may deny the claim.
  • Injury is not covered by workers’ comp. Some injuries may not be compensable under workers’ compensation, such as emotional injury or mental health problems that are not accompanied by a physical injury.
  • Medical report does not support the accident report. Insurers will review your case to confirm that your version of events is consistent for each person you have told, and that your version is consistent with a doctor’s description of your injuries. Even slight differences between the accident description you give your supervisor and the one you give your doctor can negatively impact your claim.

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, simply fill out the online contact form on this page.

 

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