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What to do if your workers’ compensation claim is denied

On Behalf of | Mar 20, 2023 | Workers' Compensation |

In 2021, 2,607,900 people received injuries and 5,190 people died in workplace-related incidents. In addition, for every 100 individuals who work full time, 3.4 individuals file a workers’ compensation claim.

In 2020, the average compensation for a workers’ compensation claim was $118,837. However, not all workers’ compensation claims receive approval. This is what you should do if the insurance company denies your claim.

Find out why the insurance company denied your claim

Your first step is to find out why you received a denial. Missed deadlines, incomplete or inaccurate paperwork, previous claims or a preexisting condition may result in a denial. You also need to receive medical care. Your employer can also dispute your claim. The insurance company may deny your claim if you were at fault for any portion of the injury, such as if you had alcohol in your system or behaved inappropriately at work. You also may not have provided enough evidence to prove your case.

Gather evidence

Your next step is to gather evidence of your injury. Get witness statements from anyone on the scene, and collect their contact information. Review all your documents, including your injury report and previous claim. Gather your medical records as well. You should also speak with your employer and get copies of any documents you may need.

File an appeal

You typically have 30 days to file an appeal. Therefore, as soon as you review your paperwork and gather your evidence, file your appeal. Then, you will attend a hearing in front of an administrative law judge. You can appeal multiple times if you receive an additional denial.

As you prepare your appeal, avoid speaking with the insurance company except to find out why you received a denial. Avoid recorded statements, and carefully review any settlement before signing any paperwork.