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The Most Common Reasons Workers’ Comp Claims Are Denied

Workers compensation. Law. A lawyer laptop on a desk in the offi

Workers’ compensation is a vital system designed to provide financial assistance and medical care to employees who suffer job-related injuries or illnesses. However, not all claims filed under this system are approved. At Invictus Law, P.C., we frequently encounter clients facing denials of their workers’ compensation claims. Not all of the reasons given are valid, and many can be successfully challenged with the help of a skilled workers’ compensation attorney who knows the system. See below for a discussion of the most common reasons why workers’ comp claims get denied, and contact our office for help fighting a claim denial with an experienced and successful board-certified specialist in workers’ compensation on your side.

Inadequate Evidence of the Injury Being Work-Related

One of the primary reasons for the denial of workers’ compensation claims is the lack of sufficient evidence linking the injury or illness to the workplace. For a successful claim, it is crucial to establish that the injury occurred in the course of employment and was directly related to work duties. Employees should document their injury, report it immediately to their employer, and seek timely medical evaluation. The documentation provided by healthcare professionals plays a significant role in supporting the claim.

Missed Deadlines in Reporting and Filing

Timeliness is critical in the workers’ compensation process. In California, there are strict deadlines for reporting an injury to an employer and for filing a workers’ compensation claim. Failure to adhere to these timelines can result in a denial. It’s important for employees to report their injuries promptly and ensure that all required paperwork is filed within the specified time frames.

Employment Status and Eligibility Issues

Not all workers are eligible for workers’ compensation benefits. Independent contractors, volunteers, and certain other categories of workers might not be covered under the standard workers’ compensation policy. Additionally, disputes over employment status can lead to claim denials. Workers need to understand their eligibility and seek legal guidance if there are uncertainties about their status.

Discrepancies in the Claim or Reporting

Inconsistencies in the information provided by an employee about their injury can lead to skepticism and potential denial. This includes discrepancies in the accident report, medical records, and statements made to insurance adjusters or during medical evaluations. Maintaining consistency and honesty throughout the reporting and claim process is essential.

Pre-Existing Conditions

Claims might also get denied if an employer or their insurance company believes that the injury is related to a pre-existing condition rather than a workplace incident. Distinguishing between a new injury and the aggravation of a pre-existing condition can be complex. Comprehensive medical evaluations and accurate medical histories are crucial in these cases.

Get Dedicated Legal Help Navigating Workers’ Compensation Claim Denials with Invictus Law, P.C.

At Invictus Law, P.C., we are dedicated to assisting workers in Orange County and the Inland Empire with their workers’ compensation claims. If you have experienced a denial or are struggling with the workers’ compensation process, our board-certified workers’ compensation specialist is here to help. We are committed to guiding our clients through the complexities of workers’ compensation law, ensuring they receive the benefits they are entitled to.

For more information or to schedule a consultation, contact our offices in Orange and Ontario, California by calling 949-287-5711 or 888-9WORKLAW. Let Invictus Law, P.C., be your ally in securing the workers’ compensation benefits you deserve.

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