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Common Reasons Why Workers’ Compensation Claims Are Denied

If you were injured at work and denied workers’ compensation benefits, leaving you to face the consequences of your work injury without any assistance, now is a good time to take a moment to understand why your claim might have been denied and what your course of action might be moving forward. In some cases, the denial might have been valid, but oftentimes, employers simply do not want their insurance rates to go up and, therefore, will ultimately deny a valid claim.

Below is a list of some of the most common reasons why workers’ compensation claims get denied:

  • Your application was late: There are deadlines workers have to follow when it comes to filing workers’ compensation claims. These deadlines vary from state to state, but in California, you should file your DWC-1 form within 30 days of your injury. However, there are some circumstances in which you might be excused for missing the deadline. If your employer did not advise you of your right to file a workers’ compensation claim or post proper notices, you would likely be excused from this 30-day rule.

  • There are no witnesses: Without any third parties to verify your version of events, the insurance company might try to suggest that the accident did not occur as you claimed it did. Of course, if the accident happened while you were alone, there is no way to change that, but you can always back up your claim with a medical professional’s opinion. He or she can verify that your injuries are consistent with your version of events. In the absence of any witnesses, such an opinion could be vital to the success of your claim.

  • They claim that misconduct led to your injuries: There are some circumstances in which you would not have a right to collect workers’ compensation. For example, if you were either high or drunk when you sustained your injury, the insurance company would likely refuse to pay due to your state of intoxication. This could be debatable, though you will have to show an appeals officer that any drugs that might have been in your system did not affect you at the time of the accident.

  • Your employer disputes your version of events: Your employer does not have to agree with your version of events. In fact, it is not uncommon for an employer to say that there are inaccuracies in your story, that your injuries are the result of a pre-existing condition, or that the incident did not take place at work. One way to help your case is to only discuss the details of your accident with those who are involved in the claims process. Otherwise, if you share your story with all of your co-workers, there might be some discrepancies in how each person recalls the story you told, which can lead to unfair accusations regarding the veracity of your claim.

  • You did not provide a statement or medical records: It might seem rather invasive, but the fact is that the insurance company is going to want to look at your medical records and have a right to do so. Therefore, if you fail to complete the required paperwork, the insurance company could use it as grounds for a denial of your claim.

  • Appealing a denial: In the event that the insurance company denies your claim, you have a right to file an appeal. Make sure you hire a skilled workers’ compensation attorney to ensure that this process is handled efficiently and effectively.

Workers’ Compensation Attorneys in Sacramento

If your workers’ comp claim was denied, you do not have to accept it as the final answer. You have a right to fight this decision and, at Smolich & Smolich, our Sacramento workers’ compensation team can guide you through the process from start to finish. No matter what stage you are in, we can help you take the necessary steps to achieve a favorable resolution.

If we cannot win your case, you will not owe us any legal fees!

For the representation you deserve, contact our office today at (888) 452-0703 and schedule your free initial consultation with a knowledgeable member of our legal team.

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