We’ve Got
Your Back
We’ve Got Your Back

4 common reasons for workers’ comp claim denials

On Behalf of | May 10, 2024 | Workers' Compensation |

When you suffer a work-related injury or illness, you may qualify for workers’ compensation benefits. However, not all claims get approved, and it is important to understand the reasons behind denied claims.

There are a few common reasons for workers’ compensation claims denials.

1. Failure to report the injury promptly

One of the most common reasons for denied claims is the failure to report the injury or illness within the required timeframe. In California, you should report your injury within 30 days or you might not qualify for benefits.

2. Insufficient evidence

You must have sufficient evidence that the injury or illness is work-related. A lack of evidence or inconsistencies in the claim could lead to denial. This can include conflicting medical reports, witness statements or inconsistencies in your account of the incident.

3. Intoxication or illegal activities

If your injury occurs while under the influence of drugs or alcohol or while engaging in illegal activities, you might face a claim denial. Employers have the right to enforce policies against substance abuse and illegal behavior in the workplace.

4. Missed medical appointments or treatment non-compliance

When you file a workers’ comp claim, you should also follow the prescribed medical treatment plan. Missing appointments or failing to comply with the treatment can lead to a denied claim, as it may appear that the injury is not as severe as claimed or that you lack commitment to your recovery.

Understanding the reasons behind denied workers’ comp claims can help you avoid common pitfalls. The better prepared you are when you file, the greater your chances of success.