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What happens if my workers’ compensation claim is denied?

On Behalf of | Apr 23, 2024 | Workplace Injuries

Workers’ compensation is a lifeline for many Kentucky employees who have sustained injuries while at their jobs. However, insurance companies often deny workers’ compensation claims for several reasons. Here is what you can do if your claim is denied.

Why your workers’ comp claim may be denied

The first step you need to take if your workers’ compensation claim is denied is to figure out why. The reason for the denial will be in the letter from the workers’ compensation insurance company. Understanding why you have been denied can help you prepare to appeal the decision. Some of the reasons for denial include:

• Non-work-related injury

• Employer disputes the claim

• Late reporting

• Incomplete or inaccurate documentation

• Failure to seek medical attention

• Injuries, such as stress claims, not eligible for compensation

• Discrepancies between medical reports and claims

Appealing your claim

Your denial letter will indicate a deadline for filing an appeal. Before filing one, meet with your employer to determine whether you can resolve the issue, as clerical errors or misunderstandings are common. File your appeal with the workers’ compensation commission or a similar agency. If these bodies deny the claim, take your claim to the court of appeals. This process can become complicated as it requires detailed knowledge of the law. One critical action you can take is providing comprehensive medical records that unequivocally support your claim. These records are often the backbone of a successful appeal.

Don’t give up on your claim

Many entities, including your employer, will do everything in their power to deny a legitimate workplace injury claim. Although you have no guarantee that you’ll receive compensation when filing an appeal, filing comprehensive paperwork, including your medical records and other documentation, can increase your chances of a favorable outcome. You must also file your claim within the statute of limitations.

You may also benefit from filing a lawsuit against a third party when applicable. This situation is beneficial when an outside contractor is involved in a workplace injury, especially if workers’ comp insurance continues to deny your claim.