Top 3 Reasons for Workers’ Comp Claim Denial

A workers' comp claim form with a black pen on it

After a work injury, it’s important that you get the benefits you need to get back on your feet. Paying for medical treatment on top of losing wages due to time off work is a heavy financial burden. Filing a workers’ comp claim can help you get assistance from your employer’s workers’ compensation insurance company. These benefits are often essential to injured workers. Unfortunately, these insurance companies often try to avoid paying you the money you deserve by denying your claim.

There are many reasons why claims adjusters may deny your workman’s comp claim, including:

1. Inconsistencies in your Workers’ Comp Claim

The adjuster for your case will immediately begin looking for inconsistencies after you file a claim. More often than not, these are small discrepancies that you would not notice. For example, your workers’ comp claim form may state that an injury happened at a certain time, but CCTV footage shows that it happened slightly before or after you said it did. There can also be inconsistencies between your initial account of your injury or illness and what you said to the doctor who examined you.

When time passes between your accident and your description of it to a third party, small details may be forgotten or your memory of them may be slightly different. Although these inconsistencies should not count against you, the unfortunate fact is that claims adjusters often look for any excuse to deny your workers’ comp claim. The best step you can take is to try to be as consistent as possible. You should also hire a qualified workers’ compensation attorney to be on your side. This will help minimize the likelihood of a claim denial.

2. Medical Treatment For Your Work Injury

Another important factor when it comes to workers’ comp claim denial is medical treatment. The workers’ compensation system has a variety of requirements for how and when you get treatment for your work-related injury or illness. If you do any of these steps in the wrong order, or if there are any issues with your medical provider, an adjuster can deny your claim as a result. It’s important that you see a doctor as soon as possible after your injury if you plan to file a workers’ comp claim.

One of the most important things you can do to avoid claim denial is to see a medical professional right after your injury at work. If you let too much time pass between a workplace injury and when you see a doctor, a claims adjuster may use this as evidence that your injury was not severe. Seeing a medical provider soon after the incident also helps establish a record of the events that caused your injury and its direct effects.

3. Workers’ Comp Claim Deadlines

While recovering from an injury or illness, deadlines usually aren’t the first thing on your mind. However, the workers’ compensation system relies on strict deadlines for each step of the claims process. Failing to follow these deadlines can lead to a workers’ comp claim denial. This is one reason why having a workers’ comp attorney on your side is important, as they can help you keep track of your case’s timeline.

One common missed deadline that leads to claim denial is not telling your employer about your injury. Ideally, you should tell your direct supervisor immediately after a workplace incident. This helps establish evidence that your injury occurred. It also helps you start the workers’ comp claim process as soon as possible.

Was your workers’ comp claim denied? The most common mistake injured workers make is to give up after a denial. You have the right to appeal any denied claim, and a workers’ compensation lawyer can help you in the appeals process. At the Law Offices of Bo Katzakian, we are experienced in appealing claim denials. We have offices in Stockton and Sacramento. Call us today at 209.308.1535 for a free consultation.

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