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Common reasons for denied workers' compensation claims: Part II

Last week, we began a discussion about denied workers' compensation claims. There are many reasons why valid claims may be denied, including the worker's failure to properly submit paperwork and handle other bureaucratic requirements.

In today's post, we'll discuss other reasons why seemingly valid claims are sometimes denied. In many cases, these are challenges to either the severity of the reported injury or challenges to how it occurred.

Workers' compensation insurers sometimes deny claims after determining that the employee's injuries may have been overstated. Concerns over fraud and abuse sometimes prompt insurers to deny claims that should be compensable, so an appeal is usually necessary in these cases.

Although workers' compensation is supposed to be a no-fault system (blaming neither the worker nor the employer), claims are sometimes denied for reasons or questions related to why and how the injuries occurred. Claims may be denied because the insurer believes that:

  • The employee's injuries were self-inflicted in order to file a fraudulent claim
  • The employee's injuries were caused by the employee's own willful negligence (such as being intoxicated at work)
  • The injuries occurred while the employee was goofing off or engaging in "horseplay"
  • There is no causal link showing that the injury was work-related, even if it happened at work
  • The cause of the injury cannot be determined and cannot be causally linked to work

Regardless of why your claim was denied, an experienced workers' compensation attorney may be able to help you file a successful appeal. Please visit the denied workers' compensation claims page on our website to learn more.

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