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Common Causes of Denial for Workers' Compensation

No Workers' Compensation Guide can prepare you for the feeling of being denied compensation. It can be mentally, physically, and financially challenging. Thankfully some measures can be taken to decrease the likelihood of a denial or help you cope in a scenario where it has already happened.

Common Causes of Denial for Workers' Compensation


An integral part of the process is getting the right legal counsel on your side. That's why you can contact 1-800-Injured today to arrange a free case evaluation. 1-800-Injured is an attorney and medical referral service. Call today and discover how you can give yourself the extra edge needed to overcome a denial of your compensation. 

Injuries Haven’t Been Reported On Time

The denial of workers' compensation claims can be the result of failing to report injuries promptly. Even when they don’t cause a claim to be rejected outright, delayed injury reports can cause issues with claims in other ways. In general, promptly notifying your employer of a workplace injury or illness is a way to keep your interests protected.

When Medical Documentation Is Missing

A lack of medical documentation is another common reason claims get denied. Seeking an immediate medical evaluation after an injury is about more than getting treatment for the injuries you sustained. Documentation of any diagnosis, plans for treatment, and recommendations from physicians and medical professionals are all important when it comes to seeking workplace benefits.

When Incident Reports Are Inconsistent

Discrepancies in incident reports are another reason claims get denied. The likelihood of a claim being validated increases when there is consistency between the various reports about the incident. Incident reports, medical records, and witness statements will all be heavily scrutinized to ensure they match each other and there are no discrepancies. 

When Pre-existing Conditions Persist

Workers’ compensation denials can result from the presence of pre-existing conditions.   Insurers and employers often attempt to establish these conditions as the cause of the work-related incident an employee may have suffered. Claimants must be ready to defend against this strategy with evidence that nullifies attempts to deny their claims on this basis. 

Missed Filing Deadlines

Deadlines must be met in a timely fashion. When they aren’t, negative consequences arise. One such consequence is having your workers’ compensation claim denied. In general, filing a claim late damages the strength of the claim. As a rule, filing as soon as possible yields better results. This is why filing sooner is best.

When Employer Disputes Cause Claim Denials

Denial of workers’ compensation claims can stem from conflicts with employers. Employers can argue that the injury isn’t too severe or that the cause wasn’t work-related. In cases like these, claimants need to have evidence ready to support their claim for compensation. Statements from witnesses, footage from cameras, and expert opinions can help.

When Intoxication or Violation of Workplace Policies Happens

Claims denials can result from employee conduct that causes conflict with the claims process. Violation of workplace policies or intoxication are textbook examples. Alcohol and drugs open claimants up to suspicion that their injuries are caused by poor conduct, rather than a legitimate accident. Violation of workplace policies places claimants in violation of their rights to compensation. 

When an Independent Medical Examination (IME) Finds Conflict

Insurers can request claimants to participate in an Independent Medical Examination (IME). When this happens, the insurance company chooses the doctor. Unless legally required, don’t volunteer for these proceedings. When IME findings differ from other treatment results, denials can be the result.

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