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What are some common reasons for a workers’ comp denial?

If you suffer an injury on the job while fulfilling your duties, workers’ compensation insurance should cover your medical expenses as well as a portion of your lost wages.

However, receiving a denial for your claim can be devastating. Consider the reasons the insurance company may deny your claim and what you can do about it.

Why might they deny your claim?

Some common reasons insurance companies might deny a workers’ comp claim include:

  • You have no proof of medical treatment for your injury.
  • You failed to report the injury in a timely manner.
  • Your employer disputed your claim, typically stating you received the injury outside of work.
  • You missed the deadline to file a workers’ comp claim.
  • You were not at work when you sustained the injury.

Sometimes a claim denial is valid. Other times, employers or insurance companies act in bad faith to avoid paying. For example, if the insurer avoids communicating with you, denies your claim with an explanation or delays investigating your claim, these could be signs of bad faith.

What can you do if you receive a denial of benefits?

Regardless of the reason for denying your claim, you have the right to appeal the decision. The Workers’ Compensation Appeals Board in California allows you to file a Declaration of Readiness to Proceed and await a hearing date to see your case. The board will then determine whether the insurer had a reasonable excuse for denying your claim.

To ensure the insurance company does not take advantage of you, you should take it upon yourself to learn your rights as an employee.