What To Do If You Receive A Worker’s Compensation Claim Denial

If you work for a company, your company likely pays for worker’s compensation insurance that protects you and the company financially if you receive an injury at work. However, worker’s compensation insurance companies are for-profit organizations.

Therefore, every claim receives a rigorous review, and many of them get denied. This is what you should do if you receive a denial from worker’s compensation.

Learn the reason for your denial

First, read your denial letter carefully. It may outline why your claim received a denial. If it does not say, contact the insurance company directly. Have your claim number ready when you speak with an associate. Speak with respect as you ask why the company denied your claim. It could be as simple as a paperwork mistake, e.g., you may not have signed something or missed answering a question.

Address the reason

Common denial reasons include: you delayed reporting the injury and submitting the claim, you did not seek medical treatment, your employer disputes the claim, the insurance does not cover your injury, you did things you should not do on worker’s compensation or you lack evidence. Whatever reason the insurance company gives you, start gathering as much evidence as you can. Include medical bills, witness testimonies and your injury report.

File an appeal

After you gather your evidence, file an appeal. You likely need to file within 30 to 90 days of the denial letter. Follow the appeal instructions in your denial letter carefully. An administrative law judge will hear your initial appeal, but prepare to wait to get your appeal date.

Worker’s compensation is not always an easy process, so prepare to prove your case and fight for the money you need and deserve.