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Why are some workers’ compensation claims denied?

On Behalf of | Apr 15, 2024 | workers' compensation

When a worker is injured on the job, they may be eligible for workers’ compensation benefits. These benefits are meant to provide injured workers with medical coverage and lost wages. 

An injured worker may be denied their benefits. This can make it harder for workers to recover from their injuries and stay financially secure. Here are a few reasons a workers’ compensation claim would be denied.

There is not enough supporting documentation

A workers’ compensation claim needs documentation of the injury. This can include when and how the injury happened and a medical report. The medical report may need to show that an injury prevents an employee from continuing to work. An injured worker may be required to see a medical specialist who is approved to examine workplace injuries. Without this documentation, a claim could be denied.

The injury was not reported soon enough

An injury should be reported to a manager or employer soon after an accident if a worker wishes to claim benefits. An injured worker has 30 days to report their injury. The statute of limitations in California gives employees one year to file a claim. 

The employee was not working when they were injured

Employees are typically only eligible for workers’ compensation benefits if they sustained their injuries while at work. If an employee was injured outside of work, such as in a car accident on the way to work, then their claim could be denied. 

It can help to understand why a claim was denied if you seek to appeal a decision. You can learn more about your options by reaching out for legal help.


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