Why would my workers' comp be denied?
The employers’ workers’ compensation insurance company (insurer) denies cases for many reasons. It is not unusual for the insurer to deny a workers’ compensation claim by alleging that:
Also, be aware that often the claim itself is not denied, but the extent of the injury is.
For example, it is not uncommon for a lumber MRI to show a bulging or herniated disc, and the insurance company accepts only a lumbar strain or sprain. This is important because it dictates the amount of treatment you get. Once we had a client with a traumatic brain injury that the insurance company said was only a head contusion. The insurer may also deny the claim by asserting the injured worker did not give notice to the employer within 30 days or did not file a Notice of Injury with the Division of Workers’ Compensation within one (1) year.
Be aware that most cases have denials at some point along the process.
- the injury did not happen on the job
- the injuries are pre-existing and not the result of the work accident
- the injuries claimed are degenerative and pre-existing
- medical records do not support an on-the-job injury
- and anything else that they may construe in their favor
Also, be aware that often the claim itself is not denied, but the extent of the injury is.
For example, it is not uncommon for a lumber MRI to show a bulging or herniated disc, and the insurance company accepts only a lumbar strain or sprain. This is important because it dictates the amount of treatment you get. Once we had a client with a traumatic brain injury that the insurance company said was only a head contusion. The insurer may also deny the claim by asserting the injured worker did not give notice to the employer within 30 days or did not file a Notice of Injury with the Division of Workers’ Compensation within one (1) year.
Be aware that most cases have denials at some point along the process.
If you still have any questions, feel free to contact us. We are happy to assist you by phone, text, or email.