Why Do Workers’ Comp Claims Get Denied/Rejected?

Every day, many workers get injured while working at Costco. Fortunately, workers’ comp can compensate for your damages, such as medical bills, lost wages, permanent disability, etc. However, thousands of workers are denied these benefits every year. It is important to understand the reasons why this may happen. 

The worst part is that many rejected applications are not even justified, leaving the worker feeling helpless. Then, they are forced to pay the medical bills with their insurance or fall into debt. To prevent these challenges, it helps to know the possible reasons why your claim may get rejected. 

Reasons why workers’ comp claims get denied or rejected

  • Out-of-network medical care. 

When you are receiving workers’ comp benefits, you may be required to see a specific doctor or medical provider, as stated by the council. Depending on the laws of your state, you might have to see this designated doctor throughout your recovery or at least during the first round of medical care. Your claim might get rejected if you choose to see a doctor of your own choice. 

No matter how qualified or experienced your choice of doctor may be, you should still see the specified doctor. When it comes to medical insurance, you should not take a risk. 

  • There are no witnesses. 

Remember that the insurance company is not your friend and does not want the best for you, despite what it likes to advertise. If no third party can testify that they saw the event or accident occur where you got injured, the insurance company may argue that it never occurred. An attorney can help you find the necessary evidence to prove your claim. 

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For example, a medical professional can make reports that prove your injuries are consistent with the event dates. 

  • Wrong paperwork. 

There are tons of forms to fill out and paperwork to do when it comes to legal work. Writing accurate information and submitting the forms on time is very important for your claim. If you miss a deadline or forget to include a certain piece of information, your claim will get rejected. 

Since the insurance company always looks for instances to deny your claim, you should be especially careful about the paperwork. Having an attorney gives you peace of mind because they can handle the paperwork while you recover. 

  • Pre-existing medical conditions. 

It may happen that you already had some ongoing medical condition when you were injured at your workplace. The insurance company may try to deny your claim by saying that your injuries were already there before the accident. However, you can prove that your injuries were aggravated and new ones were formed as a result of the event.




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