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3 frequently asked questions about workers’ comp claim denials

On Behalf of | Jan 4, 2024 | Workers' Compensation

Dealing with a denied workers’ compensation claim can be frustrating. If you recently received a denial on your workers’ comp claim, you probably have some questions.

There are a few common questions that you should know the answers to as you deal with your claim denial.

1. Why was your claim denied?

There are a few common reasons an insurer may deny a workers’ comp claim. Sometimes, the insurance company determines that the injury was not work-related or the evidence connecting it to your job is insufficient. In other cases, a denial results from delayed reporting, suspected fraud or generally inadequate medical documentation. Understand the reason for the denial so that you can draft an appeal that specifically addresses those concerns.

2. What options do you have after a claim denial?

You have two options to deal with a claim denial. You can appeal the denial and request a hearing. In those cases, you have the opportunity to present your information and your case at a separate hearing. Alternatively, you can also offer more supporting evidence. Additional medical records, testimony and documentation could strengthen your claim.

3. Should you keep seeing your doctor?

You might wonder if you need to continue seeing your doctor for ongoing treatment after a claim denial. Maintaining your medical treatment schedule is an important part of the workers’ compensation claim process, especially if you can get the denial overturned. Discuss your options with your medical care provider to make an informed decision.

With 2.3 million workplace injuries reported in 2022, workers need to understand their risk of claim denial and how to respond. Understanding the reason for the denial and the options available to you can make it easier to get the compensation you deserve.