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Common reasons workers' comp claims are denied

Having your workers' compensation claim denied is stressful and can put you in a really tough spot. Medical bills are piling up, you've lost wages from not being able to work and you're in desperate need of compensation. When a claim is denied, typically you'll receive a letter detailing the reason why. If you believe the ruling was unfair or made in error, you have the opportunity to appeal the denial.

Here are some common reasons a work comp claim might be denied:

  • The claim wasn't filed on time. A workplace injury should be reported as soon as it occurs; the longer you wait the more difficult it can be to prove the validity of your claim. The state of Connecticut allows you to file a claim up to one year after the injury occurred but waiting too long could cause your claim to be denied.
  • Your employer disputed the claim. There are many reasons why your employer might dispute your work comp claim, some of them include: They believe the accident was fabricated and did not occur or they argued that your current injury or illness is not a result of a workplace accident.

Were there any witnesses to the accident? If someone witnessed the accident that caused your injury, they could be very helpful with the appeal process.

  • You didn't seek medical attention. A claim will likely be denied if you never received proper medical treatment for your injury. The insurance company is not going to approve a claim based on your opinion.
  • It's a stress-related injury. Most stress-related claims are extremely difficult to prove.
  • Not enough evidence. A claim might be denied because there's not enough evidence to prove your case. It could be helpful to the appeal process if you're re-evaluated by a doctor.

Appealing your claim

If you weren't able to prove your case the first time around, you might consider consulting an attorney. Obtaining legal representation can be very helpful; lawyers that focus on workers' comp cases are experienced in this field and will be your best chance to win the appeal.

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