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Did You Get Denied A Workers Comp Claim? Here Are 4 Reasons Why It Happened.

Denied A Workers Comp Claim | Gaylord & Nantais Attorney

It’s sad that even in 2022, there are still instances of discrimination against injured workers. Can you imagine how frustrating it must be to work hard every day, only to get injured and denied your workers’ comp claim? And what’s worse is that the insurance company is saying that your injury isn’t related to your job. It makes no sense to deny a worker who has been injured on the job the financial support they need. Injured workers should not have to suffer further because of their employer or insurers’ prejudice.

The typical insurance company denies around 1 in every 6 claims. This means that most of the population will go through a denied claim at least once in their lifetime.

Many people believe that they will be compensated if they are injured at work. However, there is a misconception that workers compensation and disability insurance are same. In reality, workers compensation is more like an insurance policy that covers lost wages and medical bills if you’re injured at work. But it doesn’t cover lost wages or medical bills if you are injured off the job.

It can be difficult for employees to prove their workplace injuries. The process is complicated and specific. The fact is, many employees have been denied an injury claim because their employer or insurer could establish that the workplace incident did not occur on the job site. Hence, it would help to hire an experienced Workers’ Comp Attorney to represent you an your lawsuit.

To know more about Workers’ Compensation, refer here.

What to do in case of a denied Workers’ Comp claim?

You must consider a Work Injury or Workers’ Compensation Lawyer if you have been denied a workers’ comp claim.

The denial of your claim is just the beginning of the fight. For example, employers must follow specific protocols when they fire or lay off employees. If they fail to follow these protocols, they violate federal law and could be hit with a lawsuit. However, the burden of proof will always fall on the plaintiff to prove that their rights were violated.

Claims denials can be frustrating for the consumer, but it is sometimes necessary. When a claim is denied, the insurance company is responsible for sending a detailed explanation of the denial. If you are denied a claim, you should always read the rejection letter carefully and make sure that you understand it before you call or write in to request an explanation.

Consumers often do not provide enough information on their applications or during conversations with the insurance representative. Before you send in your next application, take time to go over the questions again and make sure that you answer them thoroughly to prevent any misunderstandings.

Why was your Workers’ Comp claim denied?

  • 1) Wrong/ Missing Documentation: According to a Workers Compensation Research Institute study, most rejected claims were due to inadequate documentation and errors in the application process. Either the employer or an attorney could have easily avoided these errors with proper guidance.
  • 2) Pre-existing Medical Conditions: If you fail to mention a pre-existing condition while filing your claim. The pre-existing condition can be used to prove that you were not injured at the workplace.
  • 3) Not Reporting the injury on time : If you get injured at work, your first step after getting medical treatment should be to report your injury to your employer. Reporting the injury should be done within 30 days of the accident. Failing to do so can have a drastic negative influence on your claim.
  • 4) Not getting proper medical treatment: The amount of your settlement is determined by the extent of your injuries. If you fail to get proper/advised treatment for your injury, it can look suspicious and fraudulent on your part.

When you are denied workers compensation benefits, it can be a very frustrating experience. Learn more about what you need to do if your workers’ compensation claim has been denied. It is important to remember that your employer has the right to appeal your claim, and you have the right to appeal their decision as well.

Contact Gaylord and Nantais Attorney at Law today. Call us today at (562) 561-2669/(213) 732-3436 if your claim has been denied.


Picture of Thomas M. Nantais

Thomas M. Nantais

Thomas M. Nantais is the Partner of Gaylord & Nantais, a legal firm specializing in workers’ compensation, in the state of California. This firm deals in getting hearing loss compensation and work related injuries compensation for those who have worked in the state of California. With his sincere efforts, Thomas is committed to meet the highest standards of the legal industry, and aims to provide the clients with an honest and aggressive representation.

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