What happens if your workers’ comp claim comes back denied?

On Behalf of | May 22, 2021 | Workers' Compensation |

If you suffered an injury at work, you know how this type of incident can have a significant impact on your family’s finances. Time off from work, medical bills and other expenses can take a toll on your financial stability, and you may need assistance to pick up the pieces. The intent of workers’ compensation insurance is to assist injured workers after a work-related illness or injury. 

Filing a workers’ compensation claim and having a legitimate injury does not guarantee you will receive these benefits. In fact, some initial claims come back denied. If this happens to you, it can be very discouraging as you deal with the aftermath of your injury, but there are options available to you. There are specific steps you can take that will allow you to continue your pursuit of benefits through your Missouri employer’s workers compensation insurance carrier. 

What happens next? 

First, don’t give up. It is certainly discouraging, but there are ways you could still secure the financial support you need. Your next step should be to determine why the insurance company denied the claim. This is typically listed in the denial letter and will likely be for one of the following reasons: 

  • You did not report your injury on time to your employer.  
  • You did not file the initial claim on time. 
  • It is not clear your injury or illness happened because of your work. 
  • Your injury did not require any medical attention.  
  • You did not include any documentation verifying your medical needs. 
  • Your employer is disputing the claim. 

Once you identify why it came back denied, you can appeal. The appeals process may include asking for a reconsideration of your claim. You may have to resubmit your paperwork, this time including additional documentation that verifies your medical needs, how the injury impacted you and more.  

Where should you start? 

Appealing a denied workers’ compensation claim can be complex and frustrating. It may be in your interests to first seek an understanding of how the application process works and what you can do to give yourself a stronger chance of success the first time. It is also helpful to understand that insurance companies do not have your best interests in mind, and it may be necessary for you to fight for the support you need after a work-related injury.  

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Andrew Tarry