Suffering a workplace injury is stressful enough, but receiving a denial for your workers’ compensation claim can make the situation even more frustrating. If your claim was denied, don’t lose hope—many denials can be successfully appealed. Here’s what you need to know about why claims get denied and what steps you should take next.
Common Reasons for Workers’ Compensation Denials
A workers’ compensation claim can be denied for a variety of reasons. Some of the most common include:
- Failure to Report the Injury on Time – In Wisconsin, you must report your injury to your employer within 30 days, but it’s best to report it as soon as possible. Delayed reporting can raise doubts about your claim.
- Missed Filing Deadlines – There are strict deadlines for filing a workers’ compensation claim. If you miss them, your claim may be denied.
- Lack of Medical Evidence – If you didn’t seek medical treatment or there’s not enough documentation linking your injury to your job, your workers' compensation claim may be rejected.
- Pre-Existing Conditions – If the insurance company believes your injury is due to a pre-existing condition rather than a workplace incident, they may deny your claim.
- Employer Disputes the Claim – Your employer might argue that your injury wasn’t work-related or that you weren’t following workplace safety rules when it happened.
- Independent Medical Exam (IME) Findings – If the IME doctor, chosen by the insurance company, downplays your injury’s severity, it can lead to a denial.
Steps to Take After a Workers’ Compensation Claim Denial
If your workers' compensation claim is denied, don’t panic. You have options to fight back and get the benefits you deserve. Here’s what you should do next:
1. Review the Workers’ Compensation Claim Denial Letter
When your workers' compensation claim is denied, you will receive a letter explaining the reason for the denial. Carefully review this letter to understand the specific issue so you can address it in your appeal.
2. Gather Additional Evidence
Strengthening your claim with more evidence can increase your chances of approval. This may include:
- Additional medical records
- Statements from coworkers or witnesses
- A second medical opinion from an independent doctor
- Workplace incident reports
3. File an Appeal
In Wisconsin, if your claim is denied, you can request a hearing before the Wisconsin Department of Workforce Development (DWD). The appeal process typically involves:
- Filing an application for a hearing
- Attending mediation or pre-hearing conferences
- Presenting your case before an administrative law judge (ALJ)
4. Consult a Workers’ Compensation Attorney
Having an experienced workers’ compensation lawyer on your side can significantly improve your chances of success. A lawyer can help gather evidence, handle negotiations, and represent you in hearings.
5. Consider a Settlement
In some cases, negotiating a settlement with the insurance company might be an option. A skilled attorney can help you determine if this is the right move for your case.
CONTACT OUR skilled Workers’ Compensation Attorney
A workers’ compensation denial isn’t the end of the road. Understanding why your claim was denied and taking the right steps can make all the difference in getting the benefits you deserve. If your claim was denied, don’t hesitate to seek legal guidance—having a knowledgeable attorney can help you navigate the appeals process and fight for your rights.
Need help appealing a denied workers’ compensation claim? Contact our office today for a free consultation and let us help you get the benefits you deserve.
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