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Can I appeal a workers’ compensation claim denial?

Regardless of industry, any job can expose workers to injuries and illnesses, with some occupations being more inherently dangerous than others. Sustaining an injury or illness can negatively impact workers’ well-being, earning capacity and future employment opportunities. Fortunately, Oklahoma employment laws offer workers’ compensation to eligible injured workers. However, not all workers are successful with their claims.

Understanding the grounds for denial

Before exploring your options, it is important to understand why the insurance company denied your claim in the first place. This will help you gauge whether there was a mistake on the application or the insurance company overlooked your application. There are several reasons why insurance companies reject workers’ compensation claims, which include the following grounds:

  • Failure to prove that the injury was work-related
  • Failure to promptly report the injury
  • Failure to seek medical treatment or complete therapy
  • The injury is not eligible for benefits
  • Inaccurate or misrepresentation of information
  • Incomplete details and documentation

Sometimes, the mistake or negligence lies with the employer or the doctor who provided the medical documentation regarding the worker’s injury.

How do I know if I can appeal?

If, upon review of the denial letter, you find that the insurance company did not provide a specific reason behind the rejection, you may consider filing an appeal. The same applies if available evidence shows the insurance company is acting in bad faith.

It is easy to feel defeated when receiving a rejection. However, a workers’ compensation denial is not absolute. If you believe you are entitled to the claim benefits despite the rejection, it is best to gather relevant evidence and prepare for the appeal process. If you have any doubts, you can consider consulting with a legal expert to know where your case stands.


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