If Your Workers’ Comp Claim Is Denied
A denial letter isn’t the final word. Many denied claims are approved after the worker provides more information or appeals. The key is to act before the deadline in the letter.
- All workers
Common reasons for denial
| Reason given | What can help |
|---|---|
| Reported too late | Proof you told a supervisor earlier: texts, witnesses, a first aid log |
| Not work-related | Witness statements, a doctor’s opinion on the cause, job duties, exposure records |
| Pre-existing condition | In most states, a work injury that makes an old condition worse is still covered; a doctor’s report explaining that |
| Not enough medical evidence | Complete medical records and a clear note on your restrictions |
| You’re an independent contractor | Proof the company controlled your work. See Misclassification. |
| Missed appointments or didn’t follow treatment | Records showing why, and a plan to resume treatment |
| Intoxication or horseplay | Test results, witness statements; the rules vary by state |
Steps to take
- Read the letter carefully. Find the exact reason and the deadline to appeal. Some are as short as a few weeks.
- Call the adjuster and ask what information would change the decision. Take notes, and follow up in writing.
- Get your records: medical records, your claim file, witness names and your own written report.
- Ask your doctor for a written opinion that your injury or illness is work-related, if they believe it is.
- File the appeal with your state workers’ comp agency. Depending on the state, it may be called a petition, an application for hearing or a request for mediation.
- Go to every hearing, mediation and medical exam you’re scheduled for. Missing one can end your case.
Free help
- Many states have an ombudsman or worker assistance office that explains the process for free.
- Your union may have a representative who helps with comp claims.
- Legal aid offices and worker centers can help or refer you. See Where to Get Help.
Hiring a lawyer
- Most workers’ comp lawyers work on contingency: no fee up front, paid a percentage of what you recover.
- Many states cap lawyer fees in comp cases and require the judge or board to approve them.
- Consider a lawyer if you have a serious injury, need surgery, can’t return to your old job, are offered a settlement, or your claim was denied.
While you wait
- Use your health insurance for treatment if you have it; it may be repaid if comp is approved later
- Ask about short-term disability insurance through your job or union
- Ask your state about unemployment benefits if you’re able to do some work and your job is gone
- If your employer had no workers’ comp insurance, ask the state about its uninsured employers fund
- Keep every letter and envelope; postmarks can matter for deadlines
Settlements are usually final. Once you settle, you may give up future medical care for the injury. Understand what you’re signing.
Standards & references
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