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Common Reasons Why Insurance Companies Deny Workers’ Compensation Claims

On Behalf of | Workers' Compensation

When you’re injured on the job, filing a workers’ compensation claim is the best way to help offset your medical expenses and give you access to a portion of your normal wage while you recover. However, filing a claim doesn’t guarantee that you’ll receive compensation. In fact, many claims get denied each year, and while working with an experienced Chicago workers’ compensation lawyer can help you appeal the decision, you still need to understand why your claim was denied.

Though every situation and case is unique, there are a few common reasons why insurance companies deny claims. Here’s what you need to know.

You Waited Too Long to File or Report Your Injury

The key to a successful workers’ compensation claim lies in reporting your injury as soon as possible. Ideally, you’ll let your employer know that you were hurt on the job right after the accident, but if you can’t or you aren’t aware that you’re injured immediately, letting them know as soon as possible is best.

If you wait too long to report the injury and initiate your claim, the insurance company may find it difficult to believe that the injury occurred at work. This can increase the likelihood that they’ll deny your claim.


The Insurance Company Doesn’t Think the Injury Is Work Related

To qualify for workers’ compensation, you must’ve been injured while performing your work-related duties. If you were injured as a result of horseplay or while on break, your claim will likely be denied. If you know that the injury happened while you were actively working, whether you were onsite or offsite, you may be able to appeal the decision. The best thing you can do is document everything that happened leading up to and during the accident. If possible, get anyone who witnessed the injury to write down what they saw. This can strengthen your case.

You’re Missing Certain Paperwork

One of the most common reasons insurance companies deny workers’ compensation claims is that the paperwork wasn’t filled out properly or was missing certain components. If your claim was denied, check with the insurance company and see why. If they tell you that you’re missing specific documents or that you made a few mistakes when filing your claim, ask if you can resubmit the documents. Often, insurance companies will let you correct these minor errors and will look at your case again.

You Didn’t Seek Medical Care

If your injury is severe enough that you’re unable to work, you’ll need to seek medical care to further document and prove the severity of the injury. If you never went to the doctor for your work-related injury, it’s likely that the insurance company will deny your claim.

You Can Always Appeal the Decision With an Experienced Chicago Workers’ Compensation Lawyer

If your claim was denied, you don’t have to accept that decision right away, You’re free to appeal your claim with the insurance company and see if they’ll review your case again. If you’re thinking of appealing, don’t try to do it on your own. Work with the experienced Chicago workers’ compensation lawyers at Anesi Ozmon, LTD. Our team will review your case and help you navigate the appeals process with confidence. Contact us to schedule a free consultation today.