Workers’ compensation benefits are designed to relieve the financial burden brought on by job-related injuries or illnesses. However, you must consult with a workers’ comp attorney and follow a careful process to get a claim approved. Although it’s possible to appeal a denial, it’s better to understand why claims are often rejected so you can prevent it from happening. Below are some of the most common reasons claims are denied.

Why Workers’ Comp Claims Are Denied

1. You Didn’t Report Your Injury on Time

If you are injured at work, you are typically required to report it to your employer within 30 days of the incident. Failure to meet this deadline may result in a claim denial because it won’t allow your employer to conduct an accident investigation that shows your injuries are directly related to your job duties.

2. Your Injury Took Place Away From Work

Workers’ comp benefits are only available to those who are injured or become ill while performing their job duties. Injuries that happen on the way to or from work or anywhere else outside of company property will be denied. The exception to this is if you were conducting business for your employer wherever the injury occurred.

3. You Failed to Provide All Your Medical Records

Submit all your medical records along with your application. These documents will detail the diagnosis and treatment of your injuries, which is used as evidence to validate your claim. Neglecting to provide all the right paperwork can be grounds for denial. Your workers’ comp attorney will help you determine which records to submit.

4. You Have a Pre-Existing Condition

If you had an injury or illness prior to getting hurt at work, there’s a good chance the insurance company will argue your current health issue is attributed to your pre-existing condition. A workers’ comp attorney will know how to prove these are two separate conditions.

5. Your Employer Disputes Your Claim

There is a chance your employer will dispute your version of events to avoid having a claim on their policy. They may say you acted in a way that contributed to your injuries or you weren’t hurt at your place of employment. Any argument from them can cause the insurance company to question your story, which is why having legal representation is vital.

If your workers’ comp claim is initially denied, you will receive a letter stating the reason for the decision. This will give you an idea of what you must do to win your appeal. However, to prevent your claim from being rejected in the first place, hire a workers’ comp attorney. The team at Vincent J. Criscuolo & Associates understands how important it is to collect benefits after being hurt on the job. They have helped numerous Rochester, NY, residents successfully navigate the application process and maximize their compensation. Contact them at (585) 232-3240 to schedule a consultation, or visit their website to learn more.