Protecting the Rights
of Injury Victims

Thomas DeLattre and Glen D. Wieland

8 reasons why workers’ compensation claims are denied

On Behalf of | Dec 14, 2023 | Workers' Compensation |

Have you been injured on the job? If so, then you know all too well the struggles that can follow a workplace accident, including the physical pain and suffering, emotional trauma, lost wages, and incurred and anticipated medical expenses. The uncertainty of it all can leave you feeling stressed, but you might take comfort knowing that you can pursue a workers’ compensation claim.

However, many workers’ compensation claims are denied, which could leave you without the financial resources necessary to allow you to focus on your recovery. If you want to avoid that from happening to you, then you need to know why these claims are often denied so that you can counter these justifications and position yourself for success.

Why are workers’ compensation claims denied?

There are several reasons why workers’ compensation claims are denied. Here are the top reasons:

  1. The injuries are not work-related: The insurance company might scour your medical records to see if there’s a way to argue that your injuries were suffered outside of work. If they’re successful in doing so, then you’re claim will be denied. The same analysis holds true if you had pre-existing injuries. Witness accounts, medical opinions, and even security footage could help you here.
  2. Horseplay: Even if your injury was suffered at work, your claim can be denied if you were goofing off or otherwise acting out of line with your job duties at the time. This behavior is often observed by witnesses or caught on camera, so you’ll need to be prepared to address your role in the event that left you injured.
  3. Waiting too long to report the injury: There are strict timelines in place when it comes to reporting an injury to your employer. If you wait too long, though, then you open the door for arguments to be made that your injuries were suffered elsewhere, and your claim can end up being denied due to not adhering to the applicable timeframe.
  4. You initiated a fight: Workers’ compensation might be recoverable if you’re injured by an aggressive co-worker, but your claim will be denied if you were the instigator of a physical altercation. So, be prepared for the insurance company to lay the blame at your feet.
  5. The presence of drugs or alcohol: If it’s determined that you were under the influence of drugs or alcohol at the time you suffered your workplace injury, then the insurance company is going to have justifiable grounds to deny your claim.
  6. Lack of corroboration: You might succeed on your workers’ compensation claim based on your statements alone, but there’s certainly no guarantee. In fact, many claims that lack additional corroborating evidence are denied. So, do your best to find other witness accounts or video to help support your case.
  7. Inconsistencies: If the story of your workplace accident is riddled with inconsistencies, then the insurance company might not believe what you’re alleging. This, in turn, can result in your workers’ compensation claim being denied.
  8. Waiting too long to file your claim: There are also strict timelines on when you need to file your workers’ compensation claim. Delaying too long can result in your claim being denied, thus leaving you without the financial resources you need.

Find the best path forward in your workers’ compensation case

There are a lot of roadblocks and pitfalls in the workers’ compensation claims process. You have to avoid them if you want to recover the financial support that you need.

That’s why you need to have the foresight to plan your claim considering common mistakes and justifications for denial. Only then can you build the robust claim that you need and, by doing so, you’ll hopefully be able to obtain a robust recovery, get back to work, and reclaim your normal life.



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