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5 common causes of workers’ compensation claim denials

On Behalf of | Oct 9, 2024 | Workers' Compensation |

Have you been injured at work? You may be eligible for workers’ compensation benefits. These benefits could provide you with medical coverage and lost wages while you recover from your injuries. 

However, your benefits could be denied. There are a few common reasons this happens, including the following: 

1. Missing paperwork

There are a few relevant forms of paperwork you may need to file for workers’ comp benefits. These documents may outline the type of injuries you are suffering from, the expenses required to heal from your injuries and the financial losses caused by your injuries. Missing any documents or having the wrong information on these documents could lead to a denial.

2. Missed deadline

To apply for workers’ comp benefits, you must meet two statutes of limitations. The first deadline requires you to report your accident and injuries to your employer within 30 days of the accident. The second deadline requires you to file for benefits within 2 years. Missing any of these deadlines may make it harder to receive benefits.

3. Injured outside of work

Workers’ comp is typically not available if you were injured outside of work. There are a few exceptions, such as if you were driving for your job when you suffered your injuries.

4. Insufficient medical treatment

One of the documents you may need to receive benefits is a medical report. You may need to see a doctor that specializes in workplace injuries. If you do not get a medical report, your benefits could be denied. 

5. Roughhousing or substance abuse

Workers’ comp is a no-fault system, meaning benefits could still be obtained regardless of how an accident was caused. While workers’ comp is a no-fault system, there are a few ways that benefits could be denied. For example, if an accident was the result of fighting or substance abuse.

If your benefits were denied, legal guidance may help you explore your options.