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4 common reasons for a workers’ comp claim denial

On Behalf of | Oct 6, 2023 | Workers' Compensation |

When employees face workplace injuries, they often turn to workers’ compensation to cover medical expenses and lost wages.

However, not all claims come with approval, leaving workers in a difficult position. Understanding common reasons for denial can help employees navigate the process more effectively.

1. Late reporting

Workers should notify their employers promptly when accidents occur. Failing to report the injury within the specified timeframe can give employers and insurers a reason to deny the claim. Timely reporting ensures accurate documentation of the incident, making it more likely for a claim approval.

2. Lack of medical evidence

Another common cause for claim denials is inadequate medical evidence. When submitting a workers’ compensation claim, employees need to provide comprehensive medical records and documentation of their injury. Incomplete or unclear medical evidence can raise doubts about the legitimacy of the claim, leading to denial.

3. Pre-existing conditions

Workers’ compensation typically covers injuries that occur while performing job-related tasks. However, if an employee has a pre-existing condition, it can complicate matters. Insurers may deny a claim if it is unclear whether the injury is a result of the workplace incident or a pre-existing issue. Employers and insurers may argue that the injury was not solely work-related.

4. Discrepancies in the incident report

Accurate and consistent incident reporting is vital in workers’ compensation claims. Discrepancies or inconsistencies in the incident report can give rise to suspicion. Employers and insurers may question the authenticity of the injury if details in the report differ from the employee’s account. Ensuring a precise and coherent incident report can strengthen the chances of claim approval.

In 2021, 2,607,900 workplace illnesses and injuries happened, many of which left employees unable to work and in need of assistance. Knowing the above may help make the claims process easier.