Why Can a Workers Comp Claim be Denied?

Why Can a Workers Comp Claim be Denied?

On Behalf of Rosenthal, Levy, Simon & Sosa | February 7, 2023 | Workers' Compensation

If you got injured at your workplace or suffered a medical condition due to your work, like a lung disease because of repeated exposure to hazardous chemicals or a repetitive strain injury from cumulative trauma, you are probably hoping that you will receive workers’ comp benefits. However, some employers and their insurers may look for possible reasons to deny claims. But the reason for the denial must be valid under the law.

Common Reasons for Denying a Workers’ Compensation Claim

• Your application was missing important information, or they found alleged discrepancies between the workplace accident and the documented injuries.
• You missed the deadline for filing.
• You received medical treatment from an unauthorized doctor or hospital.
• You failed to receive proper medical treatment for the injury you’re claiming to have.
• Your injury did not happen at work or during the course of your employment.
• Your injury wasn’t severe enough to qualify for workers’ compensation benefits.
• Your employer is disputing or denying your claim.
• Your employer is alleging that you suffered the injury before the workplace accident or that your medical condition was a preexisting one.
• Your employer is arguing that you did not have sufficient evidence to prove your injuries occurred at work.

It’s also important to note that insurance providers may try to deny claims that an employee has filed after they quit, were fired, or were laid off. In some cases, the employee may have a valid reason for the delayed filing. The state may have rules for such claims, and if you are eligible for one of the exemptions, you may have the chance to contest the denied claim.

What to Do If Your Workers’ Comp Claim Has Been Denied

You can file an appeal, regardless of the reason for the denial. You should receive a letter that explains why your claim was denied and how you can appeal the decision. Depending on your specific circumstances, you may have the option of correcting an error on your application and resubmitting your claim or meeting with your employer or insurer to discuss and settle the dispute. If these options do not resolve the issue, you should file your appeal.

In most cases, workers are given two years from the date of their injury to file their appeal. But this rule does not apply if they try to appeal one particular benefit they were denied. In this case, they are only given one year from their last benefit payment or treatment date. An experienced workers’ compensation lawyer can guide you through the entire process.

Speak to an Experienced Port St. Lucie Workers’ Compensation Lawyer Today

Unless your employer’s insurance provider denied your claim because of a minor error that was resolved immediately, reach out to Rosenthal, Levy, Simon & Sosa for legal advice. Our Port St. Lucie workers’ compensation lawyer can determine the best legal recourse for your specific case. The deadlines for appealing workers’ comp claims are strict and short, and you wouldn’t want to miss out on the benefits you’re entitled to.

To arrange a free case review with our Port St. Lucie workers’ compensation lawyer, dial 866-640-7117 or reach us online today.