Why Will Workers’ Compensation Deny Benefits for Workplace Injuries?

Sustaining an injury in the workplace will typically entitle an employee to workers’ compensation benefits that cover the cost of medical care. Benefits may also include payments to cover a portion of lost wages during the period that an employee is unable to work due to his or her injuries. However, applicants will not always get the approval that they are expecting when they submit a claim for a workplace injury. Administrative problems with an application are likely to result in a denial. Also, a lack of evidentiary support for the circumstances or severity of an injury. Here are some reasons why a claims examiner may deny a legitimate claim.

Timeliness

One of the most fundamental things that applicants must do in order for a claim to be successful is submit an application before their right to do so expires. There is a limited period of time in which people may make claims after an occupational injury, so it is imperative that they notify their employers of their claim and submit any required application materials within this period. Claims examiners will automatically deny claims that are not submitted within the allotted time frame. The length of time that claims are valid may vary by jurisdiction, so you will need to find information that is specific to your state’s program. If you reside in Iowa, an Iowa workers compensation attorney can advise you about any applicable time limits and also tell you about the general timeline involved in the claims process.  

Completeness

A Workers’ Compensation examiner may want to see detailed medical records in order to authorize benefits. An application that does not contain sufficient medical evidence may not be enough for an examiner to award benefits.

You should maintain a complete copy of your medical records including visit notes and imaging studies. When you have preliminary authorization for treatment, remember to see providers who have experience working with patients who are receiving benefits through the workers’ compensation program. 

Evidentiary Inconsistencies

Discrepancies in your account of an accident when you are in the process of applying for benefits could cause rejection of a claim. Inconsistencies in witness accounts may also be problematic. Your account of what happened should mirror any internal records from your employer about the incident such as an accident report.

If your claim is rejected, be sure to initiate the appeal process as soon as possible. Many claims that are initially denied will go on to receive approval on appeal.