{"id":353596,"date":"2016-04-04T10:47:02","date_gmt":"2016-04-04T15:47:02","guid":{"rendered":"https:\/\/ability-fl-prod.internetbrands.com\/ability-law\/injury\/workers-compensation\/workers-comp-denied-here-are-your-next-steps.html"},"modified":"2023-08-24T08:26:58","modified_gmt":"2023-08-24T13:26:58","slug":"workers-comp-denied-here-are-your-next-steps","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-comp-denied-here-are-your-next-steps.html","title":{"rendered":"Workers&#8217; Comp Denied? Your Next Steps"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-9d6595d7 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n<div class=\"fl-page-articles fl-section-main fl-section-main-full-width\"><h1 class=\"fl-no-margin-top\">Workers&#039; Comp Denied? Your Next Steps<\/h1>\n\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/jade-yeban-j-d\/\">Jade Yeban, Esq.<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/katrina-wilson-esq\/\">Katrina Wilson, Esq.<\/a>\n                | Last updated\n        <time>\n                            August 24, 2023\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n\n\n<div class=\"fl-key-takeaways fl-mb30\" data-testid=\"fl-key-takeaways\">\n    <div class=\"fl-card-content\">\n        <div class=\"fl-card-body fl-card-bg-teal fl-flex fl-flex-column\">\n                            <h2 class=\"fl-card-title fl-h2 fl-no-margin\">Key Takeaways<\/h2>\n                        <div id=\"copilot-message-r36\" class=\"fai-CopilotMessage__content r1izxv8h ___7qar2c0 fcthzvy\" dir=\"auto\">\n<div dir=\"auto\">\n<div class=\"___1vve6yh f22iagw f1vx9l62 f122n59 f3bhgqh f1mnxvew fly5x3f\">\n<div class=\"___j4vmuw0 f22iagw f1vx9l62 f1869bpl fly5x3f fbc6vix\">\n<div data-testid=\"loading-message\" data-fui-focus-visible=\"\">\n<div>\n<div id=\"chatMessageResponser34\" class=\"___1yop6mf f336tjw f9ijwd5 fz7g6wx fod5ikn f1s184ao\" aria-live=\"assertive\" data-testid=\"lastChatMessage\">\n<div class=\"___1j4t0a1 f1lmfglv f1abmfm4\" aria-hidden=\"false\" data-testid=\"markdown-reply\" data-message-type=\"Chat\">\n<div class=\"___stpibi0 f22iagw f1vx9l62 fk15e71 f1k953kz f137keqj f1rncccw f1stllg3 f1w4kmmc f1tric3v f10dk5ic fx8cdsv f16nlwsl f1eookvz fhjrts3 fqugt2f f10km5jb f18d18k8 f1v1vhmp f1hdmul3 f198vjnp f2dshw1 fjpjndq fnmj2pj ffrrb40 f1mon110 fhajzam fimndk6 fxv4dng fb1rn9k f59wlhv f1xmfh30 f18yf5o5 fmr6chf fw8qy2q ff161sd f1qr7t77 f1yyogn1 foogchg fp5872b f1tpb8gf f1hdgrc8 f1vatr43 frkxccd f9pdzkb f158oiaz ft5kggy f5l4ui7 f13j03li f18xdoka f8off4e f1go6zfc f128n2ra f1jpxw2j f1lwd9n0 fy0b8hm f1g2633v fx4kvgi fkvolse f1gxrt3a f1os76ua f1js9cnw f1g87ej0 freluf8 f1yggaq6 f2i3chp f1151osp florpoh f35kzfz ftp9m57 f1e288vi fz62hnz fixvuys f1nmofwh fc1c6mv f18a2er7 fhvkrdl fhxnn68 f1oce4bo fvhlfan f7tc0t0 f1ngf1n2 ffrzq6x f1yjiq2m f1aqdgql f1huvaf f10ij78l f1k94sa4 fkmfumq f1jvzkyl f1eu24ob f1xbfc1f fmf0lwf f107dsy8 f3w566c f4648sl f13zpkng f7unjfp f8p1rz fzu6h1w f1i1bi6h f1smo7hi f1sk1xod f1kgogdq f1gjktkp ft608jz f19dd9cz fg3xr24 fhd155k f1b8gl2e fg4b9ou flb4lo fdicbfk fgwcyh1 f1jbds0d f1fb9uea f1stuka4 fcrtu6g fwqh0xn f11w66yg f6e0e65 f1vvgu0 f1607507 f1m9bycv f1ntoah8 f1b694rt faql4r2 fpjuhzh fmavl6h\">\n<p>If your workers\u2019 compensation claim is denied, it could be due to late reporting, non-work-related injury, or incomplete documentation. You have the right to appeal through your state\u2019s workers\u2019 compensation board, but deadlines and procedures vary by state.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div><\/div>\n<div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"fai-CopilotMessage__footnote r1bn3aft ___7qar2c0 fcthzvy\">\n<div class=\"___648pct0 f1lmfglv f527xm8 f1hdris8\" dir=\"ltr\" data-testid=\"foot-note-div\"><\/div>\n<\/div>\n<div class=\"fai-CopilotMessage__actions rmlvq19 ___7qar2c0 fcthzvy\" role=\"toolbar\" data-tabster=\"{&quot;mover&quot;:{&quot;cyclic&quot;:false,&quot;direction&quot;:2,&quot;memorizeCurrent&quot;:true}}\"><\/div>\n\n        <\/div>\n    <\/div>\n<\/div>\n\n\n<p>Workplace injuries are generally covered by an employer&#8217;s\u00a0workers&#8217; compensation\u00a0insurance. This is an insurance program that benefits workers who have suffered a personal injury or illness due to their job. The insurance company handling the\u00a0<a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-comp-benefits-explained.html\">workers&#8217; compensation<\/a> benefits compensates injured workers. This financial assistance is used for lost wages, medical expenses, and other related costs.<\/p>\n<p>But not all workers&#8217; compensation cases are approved. Sometimes, the insurance company might deny a workers&#8217; compensation claim. This can leave injured employees without help.<\/p>\n<p>If your claim for workers&#8217; comp is denied, you still have options. You may appeal the denial through <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-laws-by-state.html\">your state&#8217;s board of workers&#8217; compensation<\/a>. However, there are various reasons why a claim may be denied.<\/p>\n<p>This article will help you determine what steps to take if your claim for workers&#8217; comp is denied. Keep in mind that specifics vary by state.<\/p>\n<p>A local <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation.html\">workers&#8217; comp attorney<\/a> can help you understand your rights and legal options under your state&#8217;s workers&#8217; comp laws. Choosing to work with an attorney can strengthen your appeal and improve the chances of receiving the benefits you deserve.<\/p>\n<h2>Why Workers&#8217; Comp Claims Are Denied<\/h2>\n<p>If your claim for workers&#8217; comp was denied, the first thing you need to do is determine why. This should be explained in the denial letter. You may be denied if you do not meet the eligibility requirements. Still, you may appeal if you believe the denial was reached in error.<\/p>\n<p>There are several reasons why an insurance company might deny a claim. Understanding these reasons can help injured workers better navigate the claims process. Common reasons for the denial of works&#8217; comp benefits include:<\/p>\n<ul>\n<li><strong>Non-work-related injury<\/strong>:\u00a0If the insurance company believes the personal injury was not due to a\u00a0<a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/what-types-of-injuries-are-compensable-under-workers-compensation.html\">work-related injury<\/a>, they can deny the claim. For instance, they might reject the claim if the injury occurred outside of work or is due to a pre-existing medical condition.<\/li>\n<li><strong>Employer disputes claim<\/strong>:\u00a0Your employer may claim the accident was non-work-related. They might argue that the claim happened outside of work due to horseplay or some other disqualifying reason.<\/li>\n<li><strong>Late reporting:<\/strong>\u00a0Workers&#8217; compensation laws require injured employees to report their job injuries. It should be reported to their employer within a particular time. The insurance company might only accept your claim if you report your injury in time. Check your\u00a0<a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-statute-of-limitations-by-state.html\">state laws&#8217; statute of limitations<\/a>\u00a0for workers&#8217; compensation claims.<\/li>\n<li><strong>Incomplete or inaccurate documentation<\/strong>:\u00a0Providing insufficient information about your injury and medical care can result in claim denial. This might include incomplete medical records, inconsistent statements about the injury, or failure to provide requested documents.<\/li>\n<li><strong>Failure to seek medical attention<\/strong>: If injured workers do not seek immediate medical attention after their injury, it can lead to claim denials. The insurance company might argue that the lack of immediate medical care implies the injury was not serious. You must obtain medical treatment to receive workers&#8217; comp benefits. The bottom line: if you are hurt, seek medical care immediately.<\/li>\n<li><strong>Injury is not compensable<\/strong>:\u00a0Claims for stress-related injuries, for example, are difficult to prove in many states. By contrast,\u00a0<a href=\"https:\/\/www.findlaw.com\/state\/california-law\/california-workers-compensation-laws.html\">California workers&#8217; comp laws<\/a>\u00a0specifically cover stress-related injuries.<\/li>\n<li><strong>Discrepancies between medical reports and claims<\/strong>:\u00a0If there are inconsistencies between what the claim says and what medical bills or reports indicate, the insurance company may deny the claim.<\/li>\n<\/ul>\n<p>There are several other reasons why your workers&#8217; comp claim may have been denied. In the event of a denied workers&#8217; comp claim, injured workers have the right to appeal the decision.<\/p>\n<h2>Appealing a Workers&#8217; Comp Denial<\/h2>\n<p>You may appeal the decision once you know why your claim was denied. This process typically involves filing an appeal. This appeal is filed with either\u00a0the workers&#8217; compensation commission or\u00a0a similar\u00a0agency your state may have. If the commission also denies the claim, the injury claim can be taken to the court of appeals.<\/p>\n<p>The denial letter should provide a deadline for filing your appeal. The deadline is determined by state law. In\u00a0<a href=\"https:\/\/www.findlaw.com\/state\/maryland-law\/maryland-workers-compensation-laws.html\">Maryland<\/a>, for example, you must file your appeal within 30 days of receiving the denial letter. Before you launch an appeal, you should meet with your employer to determine whether the dispute can be resolved. It could be a clerical error or a simple misunderstanding.<\/p>\n<p>Appealing the decision can be a complicated legal process. An experienced <a href=\"https:\/\/lawyers.findlaw.com\/workers-compensation-law\/?fli=dcta\" target=\"_blank\" rel=\"noopener\">workers&#8217; comp attorney<\/a>\u00a0is best equipped to handle it. The appeal process can be complex and requires detailed knowledge of\u00a0<a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-laws-by-state.html\">workers&#8217; compensation laws<\/a>.<\/p>\n<p>It is essential to provide clear and consistent evidence to support your claim. This includes comprehensive medical records that show the extent of your injuries. The paperwork should also show the associated medical expenses.<\/p>\n<p>The appeals process varies by state, but often involves a hearing before an administrative law judge. This may occur through the <a href=\"https:\/\/www.findlaw.com\/employment\/legal-help-and-resources\/state-labor-agencies.html\">labor department<\/a> or the state workers&#8217; compensation board. There may be multiple levels of appeal, but it is essential to check your state&#8217;s laws for specifics. Talk to a legal professional for more help.<\/p>\n<h2>Get Professional Legal Help With Your Workers&#8217; Comp Appeal<\/h2>\n<p>You may feel defeated by a workers&#8217; comp denial letter, but you still have options. In many cases, you can successfully appeal your denial. But you may want to work with an experienced legal professional to ensure everything is handled correctly. Accepting a denial of benefits can be financially devastating, so you&#8217;ll want a strong ally in your corner.<\/p>\n<p>An attorney can do more than provide legal advice. They can also:<\/p>\n<ul>\n<li>Help you understand your rights<\/li>\n<li>Recommend next steps<\/li>\n<li>Guide you through the appeals process<\/li>\n<li>Represent you in hearings or in court<\/li>\n<li>Communicate with the insurance company on your behalf<\/li>\n<\/ul>\n<p>This can be very helpful when overturning a workers&#8217; compensation denial. Working with an attorney increases your chances of a successful appeal.<\/p>\n<p>Because state law is relevant, your lawyer should be licensed in the state where you work. FindLaw\u2019s directory of <a href=\"https:\/\/lawyers.findlaw.com\/workers-compensation-law\/\" target=\"_blank\" rel=\"noopener\">workers&#8217; comp attorneys<\/a> can get you started. Select your state or city to review contact and ratings information for local experts. Your search results will also link you to additional details about the attorneys\u2019 experience with workers&#8217; comp and disability appeals.<\/p>\n\n\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <g id=\"thumbs-up\" 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<fieldset>\n                    <legend class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this not helpful?<\/legend>\n                    <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n                        <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--missing-info\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Missing Information\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n               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          class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Other\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--negative-other\"\n                        >Other<\/label>\n                    <\/div>\n                <\/fieldset>\n            <\/div>\n            <div class=\"was-this-helpful__form-buttons-container\">\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--positive at-feedback-submit fl-button secondary\"\n                    type=\"submit\"\n                >\n                    <span class=\"fl-button-content\">Submit<\/span>\n                    <i\n                        class=\"fa fa-angle-right medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--cancel fl-button primary disabled\"\n                    type=\"reset\"\n                >\n                    <span class=\"fl-button-content\">Cancel<\/span>\n                    <i\n                        class=\"fa fa-times-circle medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n            <\/div>\n        <\/form>\n    <\/div>\n    <div class=\"was-this-helpful__thank-you-message\" role=\"status\">\n        <i class=\"was-this-helpful__thank-you-message-icon fa fa-check\"><\/i>\n        <p class=\"was-this-helpful__thank-you-message-text\" aria-live=\"polite\"><\/p>\n    <\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"fl-section-sidebar\"><div class=\"fl-editors-summary\" data-testid=\"fl-editors-summary\">\n    \n    <div class=\"fl-editors-summary-content\" data-testid=\"fl-editors-summary-content\">\n                    <h2>Can I Solve This on My Own or Do I Need an Attorney?<\/h2>\n                <div class=\"fl-editors-summary-content-main\" data-testid=\"fl-editors-summary-content-main\">\n            \n        <\/div>\n        <ul class=\"fl-list-style-none\">\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    A lawyer can help seek fair compensation on your behalf\n\n                <\/li>\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    Accident and injury claims are complex and 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