Why was my workers' compensation claim denied?

Workers' Compensation Lawyer in Milwaukee - Call (414) 240-0795

Has your workers’ compensation claim been denied? An initial denial does not necessarily mean you won’t be able to collect benefits for your injury. Seek the advice of an experienced workers’ compensation attorney in Milwaukee to determine the best steps to take in your situation. At Cooper Law Group, we provide effective and personalized legal services to clients with denied claims.

Common Reasons for Claim Denials

Insurance carriers may decide to deny claims for a number of reasons. The first step is to determine why the claim has been denied. Often, initial denials are approved upon appeal. However, the reason the claim has been denied can influence the outcome of an appeal.

Some of the reasons claims are frequently denied include:

• Missing information – Many claims are denied simply because information was missing on the claim form. If your claim was denied for this reason, double check your paperwork to make sure all required documents and information is included.
• Failing to notify your employer – Most insurance carriers recommend immediately notifying your employer about a work-related injury or illness. However, you have up to two years to file a claim. If you do not meet this deadline, you may forfeit your benefits. This deadline does not apply to occupational illnesses.
• They don’t believe the injury was job-related – A claim may be denied if the employer or their insurance carrier believes the injury occurred outside of work. An injury must occur while you were performing your job duties to be covered.
• The injury is related to a documented physical problem – A claim may be denied if the insurance carrier believes the injury is the result of a pre-existing physical problem.
• They believe you were responsible for your own injury – Workers' compensation is a no-fault system, meaning that workers do not have to prove that another party acted negligently in order to collect benefits. With that being said, workers whose injuries involved alcohol or drug intoxication, horseplay, roughhousing, or practical jokes are not entitled to make a claim under workers' compensation.
• You saw a doctor that was not approved – Under the workers' compensation system, your employer and their insurer have the right to provide you with a list of approved doctors you can be treated by in the event of a workplace accident. Insurers may attempt to deny your claim if you saw a doctor that was not pre-approved.

When a claim is denied, the employee may have trouble obtaining benefits for medical bills, lost wages, or vocational rehabilitation. Our law firm strongly represents clients with denied claims. We can evaluate your situation and discuss your options.

What to Do When a Claim is Denied

If your workers' compensation claim was initially denied, do not give up hope. Our Milwaukee workers’ compensation attorney can assess your claim and provide well-informed legal advice about the best course of action in your situation. In some cases, disputes can be settled with alternative dispute resolution methods, such as arbitration or mediation. When this is not possible, you can formally request an Administrative Law Judge hearing to resolve the dispute.