Workers' Compensation Claim Denied: Now What?

If you were recently injured at work and need help covering your medical bills or other expenses, there's a good chance you've filed a workers' compensation claim with your employer. Unfortunately, if you've received a notice that your claim was denied, you may be panicking and wondering how you'll cover those expenses yourself.

Workers' compensation claims are frequently denied--often wrongfully so. By knowing your rights as well as what steps to take next, you can fight back for the compensation you may be entitled to.

Determine the Cause for Denial

By law, the reason for your claim denial should be provided in-writing. When you received the notification that your claim was denied, there should have been a detailed explanation for the denial. Some common reasons that initial workers' compensation claims are denied include:

  • lack of medical treatment
  • your employer has disputed the claim
  • you didn't file the claim in time
  • the injury wasn't reported in time
  • the injury does not seem to be work-related

Consult With an Experienced Attorney

Once you're aware of the exact reason for your claim denial, it's time to consult with an attorney. Specifically, you'll want to speak with a workers' compensation attorney to determine your next best steps and receive the advice you need to move forward. A consultation with a workers' compensation attorney shouldn't cost you anything. To get the most out of your consultation, be sure to bring your denial letter and any other documentation related to your claim.

File a Formal Appeal

If your workers' compensation attorney believes your claim was wrongfully denied, he or she may encourage you to file a formal appeal. In most states, you have up to 30 days to do this after your denial notice was received, so you'll want to act quickly here. 

In filing an appeal, you'll want to make sure you also submit as much evidence as possible to support your claim. Your attorney can assist you here. For example, if your claim was initially denied because your injury was deemed non-work-related, you may need to get a statement from a medical professional that your injury happened on-the-job.

Many states have different levels of appeal, with some appeal decisions needing to be handled in court. If this is the case with your appeal, your workers' compensation attorney will be able to accompany you to your formal hearing and provide additional guidance throughout the process.