It is surprisingly common for people to receive a notice of denial after they first apply for workers’ compensation benefits. However, you should not necessarily conclude that a notice rejecting your claim means that you are not eligible for benefits. Many people can successfully appeal a workers’ compensation determination.
Claims examiners need to be thorough and objective, and they may need more information supporting your claim before they can approve it. Here are some reasons why an examiner may turn down your claim when you first submit it.
Insufficient medical information
A lack of documentation is a frequent basis for denial of benefits. Without supporting documentation, a claims examiner may conclude that you have not proven that you suffered an injury.
Lack of witnesses
The absence of witnesses should not automatically preclude your ability to get compensation. Nevertheless, not having witnesses could create grounds to challenge the circumstances of your injury.
Scope of employment
Workers’ compensation applies only to injuries that relate to your regular job duties. If an injury occurs outside of the scope of your employment, an examiner may deny your claim. The question of whether a certain activity relates to your employment may be subjective or debatable. However, claims that arise out of accidents in which people get hurt going to or from their regular workplace are usually not eligible for benefits.
The appeals process for workers’ compensation can help you get a comprehensive review of your claim. Gather all of the information that you think is relevant so that you will have evidentiary support for your appeal.