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Why are workers’ comp claims sometimes denied?

On Behalf of | Jun 5, 2024 | Workers' Compensation

When you file a workers’ compensation claim, you expect to receive benefits to cover medical expenses and lost wages. Unfortunately, claims sometimes get denied, which could leave you in a difficult position.

You should understand the most common reasons for denial before you file your claim.

Failure to report the injury promptly

One of the most common reasons for claim denials is failing to report the injury or illness within the required timeframe. In Virginia, you have 2 years from the date of the accident to file a claim.

Insufficient evidence

To approve a workers’ comp claim, the insurance company needs sufficient evidence that the injury or illness is work-related. If your claim lacks medical records, witness statements or other supporting documentation, you may receive a denial.

Pre-existing conditions

If you have a pre-existing medical condition that a workplace incident worsens, the insurance company may argue that the injury is not work-related and deny the claim.

Intoxication or illegal activity

You may receive a denial if the insurance company determines that you were under the influence of drugs or alcohol at the time of the incident or engaged in illegal activities that led to the injury.

Inconsistencies in the claim

If there are discrepancies between your account of the incident and the medical records or witness statements, the insurance company may deny the claim due to inconsistencies.

Navigating the workers’ compensation system can be challenging, especially when a claim is denied. Remember that you have options to appeal in the face of a claim denial.