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Steps to Take After a Workers’ Compensation Claim Is Denied

Injury Lawyer

Workers’ compensation is intended to protect injured workers and their employers. Most states require this coverage, though there are a few exceptions. If you were injured on the job, filed a claim with the insurance company, and were denied, you may wonder what options you have. It really depends on the reason your claim was denied, but you can appeal it if that’s in your best interest.

Why Claims Get Denied

Before choosing to appeal your denied claim, you should find out exactly why it was denied. It’s possible once you find out, you won’t want to appeal. It’s also possible once you find out, you’ll have all the evidence to show that it was a mistake. The following are some reasons workers’ comp claims often get denied.

  • The injured worker didn’t report the injury on time. Different states require a different amount of time, with Colorado being the least at four days, and other states allowing 90 days or “a reasonable amount of time.”
  • The claim didn’t get filed by the deadline. Again, the state determines this deadline, and it could be anywhere from 30 to 90 days.
  • The employer disputes the claim. Your employer may claim the injury resulted from you participating in horseplay or being intoxicated, or could claim it never happened at all.
  • Your injury isn’t considered compensable. There are certain types of injuries that are not compensable, such as “pain and suffering” type injuries.
  • You didn’t receive medical care. If your injury wasn’t bad enough to receive medical care, there’s really not much to compensate for.

What to Do Next

After learning all you can about the reason your claim was denied, you’ll be better prepared to appeal it. It’s possible that at this point, you’ll realize you were in the wrong and can’t make a successful appeal, but it’s also possible you’ll have plenty of ammunition to be successful. If you feel the denial was over something trivial, you might be able to resolve the issue with your employer directly. This could be the case if there was a simple clerical error or something similar.

If you decide to move forward with the appeal, you’ll want to get a workers’ compensation attorney involved. You’ll more than likely have to go before an administrative law judge, and your appeal may involve multiple levels. Be sure you and your attorney have collected all the evidence that will get your denial appealed so the process will run as smoothly as possible.

Contact a Lawyer Today

Having someone with legal knowledge on your side is one of the best things you can do to appeal a denied claim. To learn more, contact a workers’ compensation lawyer, like a workers’ compensation lawyer in Green Bay, WI, today.



Thanks to Hickey & Turim for their insight into some of the steps you need to take if your workers’ compensation claim is denied.