Fighting For
Employee And Union Rights
Fighting For
Employee And Union Rights

What happens if my workers’ comp claim gets denied?

On Behalf of | Jul 13, 2022 | Workers' Compensation

When an insurance company rejects your workers’ compensation claim, it can leave you uncertain and anxious. How will you pay your bills and support your family while recovering from your injury? However, you’re not alone in these fears and frustrations, as workers’ compensation claims denials can be quite common.

Why would insurers deny my workers’ compensation claim?

According to a recent report, denial rates of workers’ compensation claims rose nearly 7% from 2013 to 2017. With this data in mind, you may wonder what could cause an insurer to deny your claim and how you can challenge the denial of a claim if you face one.

Here are a few reasons they may use to denial a claim:

    • Preexisting medical conditions: Some insurance companies may use preexisting conditions as an excuse to deny your claim. That’s because many insurers often have a financial incentive for rejecting claims, including valid ones. However, having clear evidence that your injury is directly tied to work-related activities can help strengthen your case.
    • Clerical errors: Workers’ compensation claims can require extensive paperwork and adherence to strict deadlines. If you don’t file your paperwork correctly or miss specific deadlines, even if it’s for reasons out of your control, an insurance company could still deny your claim.
    • Disputes over medical care: Insurance providers can request that you see specific medical professionals. Specifically, they can direct all your medical treatment for the first 28 days including choosing the medical providers you see. If you see a medical provider during this period not directed by the insurance, they may deny your claim.

How can I appeal a workers’ compensation claims denial?

You can challenge your workers’ compensation claims denial by filling out an appeals application. Once the Michigan Workers’ Disability Compensation Agency receives your application, you may have to participate in mediation or hearings with Michigan’s Board of Magistrates. A state workers’ compensation judge may hear your case during a trial if you cannot resolve your dispute during mediation or initial appeals hearings.

Remember that you’re not alone

There are lots of reasons insurance companies deny claims. However, you can still appeal the denial. With a successful appeal, you can still earn the workers’ comp you deserve.