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Why Your Workers’ Compensation Claim May Have Been Denied

There exist several reasons why your employer’s insurer may deny your Massachusetts Workers’ Compensation claim. Knowing these reasons in advance may help you to avoid the pitfalls and delays that come with a denied claim. If your injury makes it impossible to return to work until you have recuperated, your benefits may be an important part of your recovery. A denied claim will surely add to the stress and uncertainty you may be feeling at this time.

Procedural reasons for a denial

  • Failure to report your injury promptly to your employer
  • Failure by your employer to file your claim on time
  • Failure to provide additional information requested by the DIA
  • Failure to report to a DIA-approved physician for examination if requested
  • Missing deadlines

Injury reasons for a denial

  • The injury was not work related
  • The injury is a pre-existing condition

Other reasons for a denial

  • Employee not eligible
  • Employer did not have coverage at the time of incident

What to do if you have been denied Workers’ Compensation

Like any insurance company, your employer’s Workers’ Compensation insurer will take extraordinary measures to verify the validity of every claim. However, you have the right to challenge your denial. For example if your pre-existing condition was exacerbated by your work responsibilities, then it may still be covered. Additionally, there are legal remedies if your employer was not covered at the time of your injury.

Most remedies to a claim denial have a solution. However, retaining an experienced Workers’ Compensation attorney may be the only way for you to negotiate the legal labyrinth of the Workers’ Compensation system and receive the compensation you deserve. During the challenge or Conciliation, the insurer will have its own legal council present to challenge your claim. Your attorney will know how to defend your claim during this process.

A denied claim is not something to take on alone. If you have had a Workers’ Compensation claim denied, you need to focus on getting well. Let your attorney handle your claim.

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