Why insurers reject workers’ compensation claims

On Behalf of | Jul 5, 2023 | Blog, Workers' Compensation

When you sustain an injury at work in the course of carrying out duties relevant to your position, you are eligible to receive workers’ compensation benefits if the injury results in you missing work for five or more days. Employers carry workers’ compensation insurance specifically to cover you in case you get hurt on the job, so they do not personally lose anything by paying out benefits.

However, you may find your claim initially denied. While this may seem discouraging, it is not an uncommon occurrence and you have the right to fight the decision. Insurance companies often reject first or even second or subsequent claims for various reasons.

Failure to report the injury properly

You may receive a claim rejection if you did not immediately report your injury to your employer. It is your employer’s duty to inform the insurer about the injury, so it is important to tell him or her and not assume he or she knows or will find out some other way. Your first instinct may be to go to the doctor first, but this may cause the insurer to harbor suspicions that your injury is not a workplace injury, which is another common reason for claim rejection.

The wrong kind of injury

You must sustain your injury at work during work hours to be eligible for benefits. It must also be the result of your job. While pre-existing conditions are not eligible for workers’ compensation, if you can show that your duties made them worse, you may qualify for benefits for the worsened conditions.

While you may feel dejected if you receive a claim rejection, remember that there may be any number of reasons behind it, including wrongly filled out paperwork and other reasons not specified here. You may be able to correct the issue and have the right to appeal the denial.


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