Reasons Why Your Workers’ Compensation Claim was Denied

Workers' Compensation Claim Denial San Diego.

When you file for workers’ compensation, receiving a letter stating your claim has been denied makes a terrible situation, even worse. Not only are you recovering from a workplace accident, repetitive stress injury, or work-related illness, but it is also likely that you have also spent hours filling out the paperwork necessary to receive the benefits you desperately need. All of this, only to get that letter of correspondence can feel like a major defeat; especially when you’re unable to work and are struggling to pay the ever-increasing medical bills.

If you received a denial letter from your claims administrator, the first thing to look for is the reason your claim was denied. Once you’ve determined why you’re being refused the benefits you’re entitled to, you can take action to file an appeal. What follows are a few of the main reasons why insurers deny claims.

Reasons why a workers’ compensation claim is denied

You Have a Pre-Existing Condition

If you have an old injury that was aggravated by an accident that happened on the job, you’re entitled to the same benefits as a worker who suffered a new injury. However, proving that your work actually caused the aggravation is where it gets tricky. Insurers will try to show that any impairment you have now is a result of your pre-existing condition and not the injury you suffered at work. For this reason, it’s very important to be honest and consistent when reporting details about your medical history.

There was no Witness To Your Injury

If you get hurt at work and no one was around to witness your injury, chances are your claims administrator will question it. While there’s nothing you can do to change the fact that no one saw your accident, you can help your case by reporting the incident to your supervisor and co-workers immediately. Also, make sure to tell everyone the exact same story about how and when your injury occurred. Doing so will make you appear credible and honest, increasing your chances of collecting benefits later on.

Your Workers' Compensation Claim Wasn’t Filed on Time

Time is of the essence when filing a workers’ compensation claim. Insurers assume that if you don’t report the accident immediately, you weren’t really hurt. Moreover, in California, the deadline to notify your employer of a workplace accident is five days. If you get hurt on the job and think your injury might cause you to miss work and/or require medical care, tell your supervisor and fill out an accident report immediately. Doing so will comply with the law and increase your chances of getting your benefits quickly.

Your San Diego employer disputes the workers' compensation claim

Employers actively look for reasons to deny an injured worker’s claim. After all, if your company accepts liability for your accident, its insurance premium will go up. Unfortunately, many employers are more concerned with their bottom line than paying for an injured worker’s lost wages and medical bills. Whether your employer disputes the accident happened at work or denies that your injury or illness is a result of the accident, you will need to gather additional evidence to support your case – including witness accounts and/or a statement from your doctor.

A workers’ compensation lawyer in San Diego can help

If your claims administrator sends you a letter denying your claim, you have a right to challenge that decision – and you ought to. While receiving a denial letter is certainly frustrating, it doesn’t mean you should stop fighting for the workers’ compensation benefits you deserve. 

At the Law Office of Gerald D. Brody & Associates, we’ve helped countless injured workers appeal their workers’ compensation claim denials with success. We’d be honored to provide you with the same service tailored to your specific circumstances. Call our office today to schedule your free initial consultation.