Why might the insurance company deny your workers’ comp claim?

On Behalf of | Dec 15, 2023 | Workers' Compensation

When accidents inevitably happen in the workplace, employees often rely on insurance coverage to safeguard their well-being. Workers’ compensation exists to provide financial peace of mind in the event of work-related injuries or illnesses.

However, there are instances where insurance companies may deny workers’ comp claims.  Understanding the possible reasons behind a denial can help you navigate this complex situation.

Failure to report promptly

One common reason for claim denial stems from delays in reporting workplace injuries. Timely reporting allows the relevant parties to assess the validity of claims accurately. If an employee fails to notify their employer promptly, the insurance company may question the legitimacy of the claim.

Lack of medical documentation

Comprehensive medical documentation is a requirement when filing a workers’ compensation claim. Inadequate or inconsistent medical records can raise doubts about the severity and causation of the injury. Injured employees should make sure that medical reports link the injury to work-related activities.

Pre-existing conditions

If you have pre-existing medical conditions, they may complicate your workers’ comp claim. Insurance companies may question whether the workplace incident directly caused the injury or exacerbated an existing health issue. This is another reason why thorough medical records are so invaluable for your claim.

Violation of safety protocols

Insurance companies may deny a claim if the injury occurred due to the employee’s violation of safety protocols. Injuries that occur while engaging in activities outside the scope of your work duties may also be ineligible. Demonstrating your commitment to workplace safety guidelines will strengthen your claim.

Statistics from the New Jersey Department of Labor and Workforce Development show that there were 141,594 reported workplace accidents in 2022. With these types of incidents being so common, it is important for workers to equip themselves with knowledge of what to do when an insurance company denies a workers’ compensation claim.