Was Your Workers’ Compensation Denied? Here Is What To Do Next

Worker’ Compensation insurance covers injuries that may be suffered by employees and the law requires that all employers make arrangements to cover their workers. However, there are times when compensations are denied for one or more reasons. Where your compensation is denied, you may Appeal WCB Decision through your state’s board of workers’ compensation.

Various reasons may account for the denial of your claim. Here are some of the reasons that may lead to the denial of your compensation case.

Reasons Your Workers’ Compensation Claims May be Denied

• The first thing to do when your application for compensation is denied is to find out the basis for denial. You will get the reasons in the denial letter. Your application may be denied simply for late filing or failing to meet the eligibility criteria. One such circumstance that would mean ineligibility is when you are injured while away from official work or what is commonly known as “horseplay.” However, you may still appeal if you think that the case manager erred.

• The other reason could be that the injury was never reported in good time. The timing varies from one state to the other as to when you are expected to report your work-related injuries.

• Claim not filed in Good time: State laws clearly define the deadlines for filing an official claim, which is typically 30-90 days.

• If your employer disputes your claim: Where your employer rejects or denies that the accident occurred while in line of duty, or because of any other reason, the case may be thrown out.

• If your injuries are not compensable: There are claims such as stress-related injuries, are extremely difficult to prove in many jurisdictions.

• Lack of evidence for treatment: Where the claimant doesn’t provide proof of medical treatment, he or she may not be allowed to proceed with the claim at the hearing stage.

• Weak evidence supporting a claim that the injury occurred while on duty: You may need complementary evidence to demonstrate that the injuries were work-related.

You Can Appeal WCB Decision

If you feel the denial of the case was unjustifiable, you have room to appeal the decision. You might need an expert in workers’ compensation law and the state law relating to the same to help you interpret the denial letter for purposes of finding appeal grounds. An expert will be of great help to help you make clear your evidence and allow the WCB review office to get the best presentation for purposes of reversing the earlier decision made by the adjudicator or the case manager.