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The reasons for a workers’ compensation denial

The risk of injury is always there, even if a person’s job is not inherently dangerous. Thus, workers in Oklahoma and elsewhere may suffer injuries or illnesses whether they are working in an office, factory, construction site or any other work environment that is indoors or outdoors. Because workplace incidents could occur even when negligence is not a factor, employers will have workers’ compensation insurance to help address injured workers. However, when an injured employee applies for workers’ compensation benefits, they may be met with a denial.

Reason for workers’ compensation denial

When a worker is denied workers’ comp, this will be explained in the denial letter. However, this may not be entirely clear. For some, a denial may occur because he or she simply does not meet the eligibility requirements. This may be because the injury occurred while away from work or due to horseplay in the work environment.

The following six reasons are the most common reasons for a workers’ compensation denial. This includes not reporting the injury in time, not filing the claim in time, the employer is disputing the claim, the injury is not compensable, no medical treatment was needed or there was insufficient evidence that the injury suffered was work related.

Appealing a denial

If a worker is denied workers’ comp, he or she could file an appeal. This must be filed within a certain timeframe after a denial. However, before filing an appeal, it may be helpful to meet with one’s employer or their insurance carrier to determine with the dispute could be resolved. If there is no resolution, then the appeal process can begin.

In order to be successful with an appeal, a worker should provide documentation that could help prove eligibility. This could include medical records and other evidence that could help prove that he or she is eligible for workers’ compensation benefits.

Whether you are filing an initial claim for workers’ compensation or were just denied these benefits, it is important to understand what options and rights one has. This will not only ensure one’s rights are protected but also help one move forward with the process as timely as possible.


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