Common Reasons for Denial of Workers' Compensation Claims

If you suffered an injury on the job or developed a medical condition related to your work duties, you may be eligible for workers’ compensation benefits. However, since insurance companies fund these benefits, they will look for any possible reason to deny workers’ comp claims.

The following are the most common reasons for claim denials:

  • You missed the filing deadline – In Ohio, workers’ comp claims must be filed within one year of the injury. If you inform the doctor that your injury was related to work, he/she should file the claim with the Ohio Bureau of Workers’ Compensation (BWC) on your behalf.
  • The injury did not occur at work or while you were performing job duties – If you were injured while you were on your lunch break or during your commute to/from work, then you’re most likely not eligible to file a claim.
  • You didn’t receive medical treatment after the accident – In order to receive workers’ comp benefits, you must obtain medical treatment in order to have the medical records to prove your injury. Insurance companies can say you faked your injury if you do not have supporting medical records.
  • Your employer disputes your claims – Your employer might claim that the accident didn’t occur in the way you described it. This can happen if there are no surveillance footage or witnesses to support your claim.
  • You committed some form of misconduct – While workers’ comp is considered a no-fault system, certain injuries can be denied if they were caused by failure to properly perform job duties. For instance, workers’ comp typically doesn’t cover injuries that were caused by alcohol or drug use or injuries that were self-inflicted or caused by horseplay.
  • You have a preexisting injury – If you had a preexisting injury to the same body part that was injured in your workplace accident, the insurance company may try to deny or limit your claim.

If your workers’ comp claim has been denied, do not give up! In most cases, the reason for the denial is included in the letter. If you believe it was due to mistaken paperwork or something similar, you can contact the claims adjuster in order to attempt to resolve the issue.

If not, you can always fight the decision by filing an appeal. In Ohio, you have 14 days to file an appeal by filling out a form provided by the Ohio Industrial Commission.

If you are interested in appealing a claim denial, contact our Union County workers’ comp attorney at Bridges, Jillisky, Streng, Weller & Gullifer, LLC today.

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