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Why are workers' compensation claims denied?

Imagine you are on the job, get hurt in an accident, and wind up at the doctor and in pain. You report the accident and pursue workers' compensation benefits to cover the cost of your injury and the wages you lost by not being able to work. Unfortunately, you learn that your employer or your employer's insurance carrier has denied your claim.

In this troubling scenario, it is important to determine why the claim was denied in order to assess your next steps. Below are some common reasons for denial of a claim.

  • You are not eligible for coverage because you are not an employee
  • You did not file a claim petition in time
  • Your injuries did not arise out of and in the course of your employment
  • You were intoxicated at the time of the accident
  • Your injuries were self-inflicted or intentional
  • You refused to comply with safety procedures or warnings 

However, these reasons are oftentimes not valid, so more investigation may be necessary. Denied claims can be quite upsetting, but they do not necessarily serve as the final word with regard to your benefits. As such, it can be helpful to work with an attorney from the beginning of the process to pursue the desired outcome. A legal representative can help you navigate the system and avoid mistakes that could lead to a wrongful denial of your claim. He or she can also guide you through a full trial, if necessary.

Workers' compensation benefits are often critical to the lives and well-being of injured workers and their families, so it is important to understand how the system works and what workers must do to pursue the benefits they deserve.

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