Why Some Workers’ Compensation Claims Are Denied

Workers’ compensation provides injured employees with significant benefits: medical care and loss of wages. However, this is not an automatic process. There could be several reasons why a claim is denied, which can leave workers stranded. Knowing and understanding these pitfalls can prevent you from making costly mistakes and reduce the risk of having your workers’ compensation claims denied.

Minneapolis is a city in Minnesota. Here, the workers’ compensation claims process is convoluted due to concrete deadlines and detailed documentation. A denied claim can be appealed, but it is not as simple as just saying you want to appeal, especially if your first denial relied on your lack of documentation as the basis for the denial.

A Minneapolis workers’ comp attorney can help you through the dispute process to ensure that you are getting a fair assessment and process. We have seen valid claims go in the garbage due to easily avoidable errors.

How Can Errors in Filing Cause Denials?

Filing a workers’ compensation claim requires an attentive eye when completing forms and respecting deadlines. Even small things like missing a signature or providing incomplete information can contribute to a claim being denied.

Other examples of common errors include:

• Claims submitted after the state-mandated timeframes.
• Incorrect forms or out-of-date forms.
• When the details provided about the injury or how the injury happened conflict.

It is important to double-check your paperwork and deadlines, since missing even the simplest things can delay a claim’s processing or allow the insurer to find a reason to challenge its validity.

Lack of Medical Evidence and Workers’ Compensation Claims Denied

Insurance adjusters rely heavily on medical records when evaluating a claim that supports the loss. A claim can be denied if the workers’ compensation claim notes are vague, missing, or not in agreement.

When a worker does not have detailed medical records or there is a conflict between what the worker said happened and what the doctor wrote down, the worker’s compensation claim can be severely undermined.

For example:

Workers’ compensation injuries are described subjectively with very few objective findings. A complete, accurate medical record will enhance your claim. To verify the full scope of the injury and whether it was of work-related origin.

Employer Objects to the Matter

Sometimes claims are denied because the employer objects to the injury. Examples of which the employer can object to the workers’ claim are:

• The injury was not work-related.
• That the injury was a pre-existing condition.
• There were witnesses to facts inconsistent with the employee’s version.

These objections can lead to complexity. Having complete records and good communication with the medical professionals will protect the claim if an employer presents an objection.

Type of Injury

Not all injuries will be covered by workers’ compensation. Some common limitations are:

• Stress or mental health issues with no corroborating medical documentation.
• Injuries that were incurred off-hours and unrelated to the duties of the job.
• Injuries incurred due to misconduct on behalf of the employee, or the employee violated a safety policy.

It is essential to know which injuries your state considers compensable. This will assist us in managing your approval expectations.

Claim Is Not Reported in Time

It is essential to report an injury in a timely manner, since otherwise, the insurance company can argue whether this injury actually happened while you were working for the company. The employer has notice when the injury manifests itself. This will ensure you get a fair review without the additional danger of being denied due to late reporting.

Why Workers’ Compensation Claims Denied Even for Eligible Workers?

Many reasons for denials are based on record-keeping issues. Insurers have multiple communication pathways with doctors or employees. This can be particularly the case when dealing with complicated conditions or occupational illnesses that involve more records.

Keeping records organized and being proactive is always better to enhance the likelihood of a genuine claim being approved.

Key Takeaways on Workers’ Compensation Claims Denied

• Filing mistakes and deadlines are common reasons for denial.
• Good medical records are a must.
• Employer disputes can delay and deny a claim.
• Not all injuries are compensable.
• Timeliness of reporting is key to eligibility.
• Even claims that qualify can be denied if records are mismanaged and follow-ups are miscommunicated.