Workers’ compensation allows employees to claim compensation for any medical and treatment costs they might incur following a workplace injury. But as helpful as workers’ compensation is, the truth is that not all claims get the green light.
Why was your claim denied? There could be different reasons why, as this blog hopes to explain.
Common reasons for claims denial
Here are some of the more common reasons for denying a workers’ compensation claim, as told by insurance experts:
- You accessed out-of-network medical treatment – Most workers’ compensation insurers require employees to consult only with the insurance company’s network of medical care experts.
- Your injury or illness was unrelated to your work – You can’t claim workers’ compensation for injuries or illnesses sustained outside of work. But if you got injured or caught a disease at work without witnesses verifying your claims, your claim might be denied similarly for lack of proof. In addition, insurers could deny compensation for any injuries or illnesses resulting from a pre-existing medical condition.
- You missed the claims deadline – When you get a workplace injury, filing for a claim as soon as possible is essential. If you miss the deadline, the insurer will reject your claim, no matter how grave your injuries are.
- You didn’t seek medical treatment – It might be tempting to skip a visit to the doctor if your injury appears to be minor, but this could lead to the rejection of your claim should your condition worsen. Immediate medical evaluation is essential for the healthcare professionals and the insurer to understand the severity of your injury and what they can do to treat you fully.
If an insurer denied your workers’ compensation claim, but you are sure you avoided any of the issues above, it is best to seek legal guidance to understand why. Do not hesitate to get your questions answered at any stage following a workplace injury.
