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Common reasons for workers’ compensation claim denials

| Feb 2, 2021 | Workers' Compensation

Receiving a notice informing you that your workers’ compensation claim resulted in denial is a huge blow in most cases. Starting when you first entered the workforce, you came to believe that workers’ comp would be there for you after a work-related injury. Now, you have learned at the worst possible time that these benefits are not guaranteed.

Why was your claim denied?

Sometimes, a claim is denied for administrative reasons like an incomplete report or claims form. Other times, the denial revolves around how your injury or accident occurred. Below is a brief list of the top reasons for a workers’ compensation claim denial in Cary, NC:

  • Waited too long to file: You must file for your benefits within a specific period, which is two years in North Carolina.
  • Cannot determine the cause of injury: Before approving your claim, the worker’s comp board must determine how your injury occurred.
  • Failed to report to the employer: You must report the injury to your employer within 30 days of the incident.
  • Injury not work-related: The state workers’ compensation board must find a link between your work and your injury.
  • Horseplay or negligence: Contributing to or causing your injury by violating your employer’s safety policies often results in denials.
  • Missed doctor appointments: Keeping your medical appointments allows officials to verify your claim and determine the benefits you are due.

In short, you bear some responsibility in preparing your claim for the best chance of approval. For many, the services a law firm provides fills a critical role in making sure your claim is well-prepared and free of errors.

Those who receive a denial notice have the right to an appeal. In many cases, legal guidance can ensure your second attempt to collect benefits is successful.