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Why are workers’ compensation claims denied?

On Behalf of | Jan 19, 2021 | Workers' Compensation

Workers’ compensation is an important form of insurance that many employers carry to provide their workers with financial support when those workers are hurt while on the job. All across the New York, many men and women rely on workers’ compensation payments to keep their families financially secure while they heal from their injuries. However, not all claims for workers’ compensation are approved for payment.

Denials of workers’ compensation claims are unfortunately common. They can have different bases on which the denials stem, and attorneys who practice workers’ compensation law can help their clients understand what steps they may take to appeal their determinations. This post offers information only on common grounds for workers’ compensation denials. No part of this post represents legal advice.

Denials based on technical issues

In some cases, workers’ compensation claims may be denied for allegedly technical deficiencies. For example, a claim may be denied because it is allegedly too late based on the timing of the worker’s injury. Additionally, a claim may be denied if the worker did not report their injury to their employer in a timely manner. Other technical denials may be based on a worker’s lack of need for medical care or a claim based on an ailment not covered by workers’ compensation.

Denials based on substantive issues

A worker may do everything right in terms of the technical aspects of their claim but still receive a denial. These denials are often based on the substantive claims made by the worker. An employer may allege that a worker’s injury was caused by their own actions or horseplay at work and not by a job duty. An employer may also claim that there is no way to prove that a worker’s harm was caused by their work rather than another reason.

Receiving a denial of workers’ compensation benefits can be overwhelming and scary. When it happens, a worker can seek the support of a dedicated workers’ compensation attorney. Professionals in this field can provide their clients with guidance on their individual cases and ways to pursue and protect their workers’ compensation claims.