How To Deal With Workers' Compensation Claim Denials

When a work-related injury or illness causes you to file a workers' compensation claim, the chances of an approval hinge on several factors. Not all claims are approved but there are actions you can take to make sure you are not prevented from getting the benefits you need. Read on for a list of common claim denial reasons and how to deal with each of them.

1. You have a preexisting condition – In theory, having a preexisting condition does not automatically disqualify you from being approved for benefits. If you have a preexisting condition and it got worse while working, you should be covered. Unfortunately, the insurance carrier often objects on the grounds that the vast majority of your present condition is not due to the recent work-related injury but to your previous one. This is often resolved by use of an independent medical exam. With this exam, you must be able to show how the work injury has resulted in enough additional damage to warrant coverage.

2. Your injury was not significant – Denials of this nature are often based on the fact that you failed to seek medical treatment in a timely manner. If you are hurt, see a doctor as soon as possible. If the injury is too minor to be treated, it's too minor to be covered by workers' compensation insurance.

3. Your injury occurred while not at work – While your injury is covered as long as it was in the scope of the job, you don't necessarily have to be on employer property when it happens. Generally, you are covered if you are hurt while:

  • Traveling to and from other locations (including your home) while using a company vehicle.
  • Participating in company-sponsored, paid or mandated training or industry events.
  • Meetings and appointments for work-related reasons.

4. You were not an employee at the time of the injury – Workers' compensation only covers direct employees, so that means contractors, freelancers, day-laborers, temporary employees, etc, are not covered. You may be covered if by the contracting agency, however.

5. You are alleged to have been under the influence of an illegal substance – One of the first medical procedures performed when seeking treatment for a work-related accident is a blood and urine test. If this test reveals substances like alcohol, opiates, and other drugs you might face an automatic denial of benefits. If the substance was a legally-prescribed medication, you may need to speak to a workers' compensation attorney.

If you are unable to have your claim reinstated by working with the insurance carrier, you may need legal help. You are entitled to an appeals process so speak to a workers' comp attorney today. Visit a website like to learn more.