When can your workers’ compensation claim be denied?

On Behalf of | Dec 9, 2022 | Workers' Compensation

A good number of workers’ compensation claims do not sail through due to various reasons. For the affected individuals, it means paying any medical expenses out-of-pocket, not to mention the wages missed as they recuperate from their injuries.

It helps to understand why your workers’ compensation claim could be denied and your options when this happens. Below are some of the common reasons why your claim may be unsuccessful:

1. Your injury was not work-related

Workers’ compensation only covers accidents that happen in the line of duty. While it does not necessarily mean that you must be at your job, you must have been performing a work-related activity at the time of the accident to recover any benefits.

For instance, you can claim benefits if you were out driving on a work assignment when the accident occurred. However, if you were attending to other duties unrelated to your job, you may not get any benefits.

2. Lack of sufficient medical evidence

It is crucial to get medical attention after a workplace accident as it can help prove your injuries and their extent. Without a doctor’s report, it can be hard to show that you suffered injuries from the accident or how long it will take you to recover and get back to work. 

Remember to see an authorized doctor unless it is an emergency. You may not recover any medical benefits if your employer has not approved your treating doctor.

3. Failing to report your injury on time

There are specific timelines associated with workers’ compensation claims, and it is advisable to adhere to them. For instance, you have up to 90 days to inform your employer of a workplace accident in New Jersey. If you go beyond this legal window without valid cause, your claim is likely to be denied.

What can you do about a denied claim?

First, it is necessary to understand why your claim was unsuccessful. Sometimes, it may be due to minor clerical errors or missing information. If not, you can still appeal the denied claim and have the decision overturned. However, it is best to have an informed assessment of the prevailing situation to determine the best course of action.