Reasons for Possible Workers’ Comp Claim Denials

Reasons for Possible Workers’ Comp Claim Denials

By Pyle Law, Reviewed by E. Thomas Pyle March 16 2021 9:36 pm

Your workers’ compensation claim is not guaranteed to be accepted and paid at first. Here are some reasons why your initial claim filing would be denied, and you would need to appeal with the help of a Kansas workers’ compensation attorney.

If the insurance company denies your initial workers’ compensation claim, it is certainly stressful. However, it is not the end of the world because you can successfully appeal. First, you need to understand why your claim was denied. Here are five common reasons for claim denial.

The Injury Was Not at Work

Workers’ compensation claims are meant to pay workers for on-the-job injuries. Insurance companies may try to say that you were either injured elsewhere or had some sort of pre-existing condition that makes this not a workplace injury. 

The Injury Was Not Reported in Time

When you are injured at work, there are strict reporting timeframes that you have to let your employer know what happened. Here are the reporting requirements in Kansas: 

• If there was a specific injury with a date, the employee has 20 days to let their employee know. 
• If your employment ended, you have ten days after their employment ended to report the injury. If you miss this deadline, you may lose the chance to receive benefits. 
• If you received medical treatment for a repetitive use type condition such as carpal tunnel syndrome, you have 20 days from the date of treatment to report.

Your Employer Wants to Be Difficult

When you successfully file for workers’ compensation benefits, it raises the cost of insurance for your employer. Sometimes, they have a financial self-interest in fighting you. Alternatively, they may just want to make it harder for you. Your employer could just be trying to force you to appeal.

There Was an Error in Your Paperwork

The insurance company will make a decision on your claim based on the file that they see in front of them. If you forgot to provide some required information or answered a question incorrectly, it could lead to denial. This is one reason why it is helpful to have an attorney working with you on your claim from the outset. They could assist you with the paperwork and avoid errors in the process. 

There was a Problem with Your Medical Records

In order to qualify for benefits, you need medical records to prove your claim. You need to see an approved medical provider, and your injury needs to be thoroughly documented. Alternatively, the insurance company could find that you did not receive medical treatment in the first place, meaning that there is no injury. 

You can expect that your initial workers’ compensation claim will receive strict scrutiny, so it is vital to ensure that your file is correct.

Contact a Kansas Workers’ Compensation Attorney

If you have been injured on the job and need legal help, call a Kansas workers compensation attorney at Pyle Law at (620) 241-9000 or contact us online. We can assist with your claim and could fight for you if your initial claim was denied.