Can a workers’ compensation claim be denied?

A workplace accident can spell disaster for families. An employee who is injured at work may not be able to provide for their family and could face medical bills and wage loss. When an employee is injured during a workplace accident, they may be entitled to workers’ compensation benefits. These benefits allow workers to receive coverage for medical bills and lost wages.

However, just because an employee is injured at work does not mean they will receive benefits. There may be an issue that causes a workers’ comp claim to be denied. There are a few common reasons workers’ comp claims are denied. Here is what you should know:

Why might a claim be denied?

Workers’ compensation claim denials can happen frequently. Here is why a claim may be denied:

• Statute of limitations: Workers must file a workers’ comp claim within crucial deadlines. In California, a workplace injury must be reported within 30 days of the accident. A workers’ comp claim must be filed one year from the date of the accident. Missing the deadlines can lead to a denial.
• Injured outside of work: Workers are typically only eligible for workers’ comp benefits if an accident happened at work. Any injuries outside of work can lead to a denial. 
• Self-inflicted wounds: An employee cannot receive workers’ comp benefits if it is discovered that their wounds were self-inflicted. 
• Medical evidence: Sufficient evidence is often required for a worker to receive workers’ comp benefits. An employee may not be eligible for benefits if they do not seek treatment from a verified workers’ comp doctor.

If a claim is denied, an employee still has the opportunity to seek workers’ comp benefits. A denial can be appealed. If the appeal is successful, an employee can receive coverage for their medical bills and lost wages.